What are the 2017 ESC treatment guidelines for percutaneous coronary intervention (PCI) in 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

The 2017 ESC guidelines recommend primary PCI of the infarct-related artery (class I, level of evidence: A), as well as new coronary angiography with PCI in patients with symptoms/signs or recurrent or remaining ischemia following primary PCI (class I, level of evidence: C). [70]  Note that in patients with coronary artery occlusion/global ischemia in the absence of characteristic ST elevation (eg, bundle branch block, ventricular pacing, hyperacute T-waves, isolated ST-depression in the anterior leads, and/or universal ST depression with ST-elevation in lead aVR) who have a clinical presentation compatible with ongoing myocardial ischemia, a primary PCI strategy (ie, urgent angiography and PCI, if indicated) is recommended. [70]

The 2017 ESC guidelines also indicate that the following should be considered for noninfarct arteries (all class IIa) [70] :

  • Routine revascularization of noninfarct arteries in those with STEMI and multivessel disease before hospital discharge (Level of evidence: A)
  • PCI of the noninfarct artery during the index procedure in those with cardiogenic shock (Level of evidence: C)
  • CABG in patients with ongoing ischemia and large areas of at-risk myocardium if the infarct artery is not amenable to PCI (Level of evidence: C)

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