What are the guidelines for performing PCI in the treatment of ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Answer

Current guidelines strongly recommend performing primary PCI in patients presenting with symptoms of less than 12 hours' duration, or those who present with cardiogenic shock or who develop acute severe heart failure, irrespective of time of delay from onset of symptoms. Guidelines also recommend considering primary PCI for patients who present between 12 and 24 hours after onset of symptoms, provided there is ongoing clinical or ECG evidence of myocardial ischemia.

PCI of the noninfarct related artery (nonculprit artery) at the time of primary PCI of the culprit lesion is under active investigation. In a meta-analysis of 9 trials comprising 2991 patients with STEMI that compared complete multivessel PCI (revacularization of infarct-related and noninfarct-related arteries) to culprit-infarct-artery-only PCI, Vaidya et al noted their findings suggested complete revascularization is safe in patients with STEMI and multivessel disease. [80] Although complete vascularization appeared to be associated with lowered rates of major adverse cardiac events, cardiac death, and repeat revascularization in this population, no reduction in all-cause mortality and nonfatal MI was observed. [80]


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