Sandbox: STEMI: Difference between revisions
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{| class="wikitable" style="width: 80%; text-align: justify;" | {| class="wikitable" style="width: 80%; text-align: justify;" | ||
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| bgcolor="LemonChiffon" | IIa - Additional lipid lowering therapy if LDL >1.8 mmol/L (70 mg/dL) despite on maximum tolerated statins. IMPROVE-IT, FOURIER || bgcolor="LemonChiffon" | Complete revascularization during index primary PCI in STEMI patients in shock. (Expert opinion) | | bgcolor="LemonChiffon" | IIa - Additional lipid lowering therapy if LDL >1.8 mmol/L (70 mg/dL) despite on maximum tolerated statins. IMPROVE-IT, FOURIER || bgcolor="LemonChiffon" | IIa - Complete revascularization during index primary PCI in STEMI patients in shock. (Expert opinion) | ||
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| colspan="2" bgcolor="LemonChiffon" | 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) | | colspan="2" bgcolor="LemonChiffon" | 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) | ||
|- | |- | ||
| colspan="2" bgcolor="LightCoral" | | | colspan="2" bgcolor="LightCoral" | III - Routine use of deferred stenting. DANAMI 3-DEFER | ||
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Revision as of 14:30, 27 October 2017
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 |
|---|---|
| Radial access | Radial access (MATRIX) |
| DES over BMS | DES over BMS (EXAMINATION, COMFORTABLE-AMI, NORSTENT) |
| Complete Revascularization | Complete Revascularization (PRAMI, DANAMI-3-PRIMULTI, CVLPRIT, Compare-Acute) |
| Complete Revascularization | Thrombus Aspiration (TOTAL, TASTE) |
| Bivalirudin | Bivalirudin (MATRIX, HEAT-PPCI) |
| Enoxaparin | Enoxaparin (ATOLL, Meta-analysis) |
| Early Hospital Discharge | Early Hospital Discharge (Small trials & observational data) |
| (Oxygen when SaO2 <95%) OXYGEN | 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 | |