Real-world adoption of the 2023 European Society of Cardiology guidelines regarding antiplatelet strategies in acute coronary syndromes: Insights from the European READAPT-2 survey.

Background The 2023 European Society of Cardiology (ESC) guidelines for acute coronary syndromes (ACS) maintained a Class III recommendation against routine pretreatment with oral P2Y12 inhibitors in non-ST-segment elevation ACS (NSTE-ACS) and downgraded pretreatment in ST-segment elevation myocardial infarction (STEMI) to Class IIb. This study evaluated real-world uptake of these recommendations across Europe. Methods READAPT-2 was a cross-sectional survey conducted one year after the release of the 2023 ESC guideline update, involving 1101 cardiologists from 21 European countries. Data from READAPT-2 were compared with those from the earlier READAPT-1 survey to evaluate temporal trends. The survey collected information on physician demographics, hospital characteristics, pretreatment practices, and preferences regarding antiplatelet therapy. Results Most respondents (83%) reported adhering to the Class III recommendation against routine pretreatment in NSTE-ACS. Overall, pretreatment rates in NSTE-ACS declined in READAPT-2 compared to READAPT-1, suggesting improved adherence to guideline recommendations. Pretreatment in STEMI was variable, with nearly 25% of respondents reporting routine pretreatment. Ticagrelor remains the most widely used oral P2Y12 inhibitor despite ESC guideline preference for prasugrel for percutaneous coronary intervention. Use of intravenous agents, including cangrelor and GPIIb/IIIa inhibitors, remains limited to around 10% of cases. Overall, there was significant heterogeneity in the implementation of the 2023 ESC recommendations across Europe. Conclusion Findings from READAPT-2 reveal a persistent gap between guideline awareness and clinical practice, highlighting the need for tailored implementation and education strategies to support a broader guideline uptake.