Sandbox: STEMI
2017 ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting with ST-segment Elevation
Changes in Recommendations
What is new in 2017 Guidelines on AMI-STEMI?
| 2012 | 2017 |
|---|---|
| IIa - Radial access | I - Radial access (MATRIX) |
| IIa - DES over BMS | I - DES over BMS (EXAMINATION, COMFORTABLE-AMI, NORSTENT) |
| III - Complete Revascularization | IIa - Complete Revascularization (PRAMI, DANAMI-3-PRIMULTI, CVLPRIT, Compare-Acute) |
| IIa - Complete Revascularization | III - Thrombus Aspiration (TOTAL, TASTE) |
| I - Bivalirudin | IIa -Bivalirudin (MATRIX, HEAT-PPCI) |
| IIb - Enoxaparin | IIa - Enoxaparin (ATOLL, Meta-analysis) |
| IIb - Early Hospital Discharge | IIa - Early Hospital Discharge (Small trials & observational data) |
| I - (Oxygen when SaO2 <95%) OXYGEN | I - OXYGEN (Oxygen when SaO2 <90%) AVOID, DETO2X |
| (Same dose i.V in all patients) TNK-tPA | TNK-tPA (Half dose i.V. in Pts ≥75 years, STREAM) |
AMI-STEMI - 2017 NEW RECOMMENDATIONS
| IIa - Additional lipid lowering therapy if LDL >1.8 mmol/L (70 mg/dL) despite on maximum tolerated statins. IMPROVE-IT, FOURIER | IIa - Complete revascularization during index primary PCI in STEMI patients in shock. (Expert opinion) |
| IIb - 1) Cangrelor if P2Y12 inhibitors have not been given. (CHAMPION) 2) Switch to potent P2Y12 inhibitors 48 hours after fibrinolysis. (Expert opinion) 3)Extend Ticagrelor up to 36 months in high-risk patients. (PEGASUS-TIMI 54) 4)Use of polypill to increase adherence. (FOCUS) | |
| III - Routine use of deferred stenting. DANAMI 3-DEFER | |