CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022

Abstract

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Interventional and Therapeutics (CVIT) society proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018. Updated guidelines for the management of AMI were published by the European Society of Cardiology (ESC) in 2017 and 2020. Major changes in the guidelines for STEMI patients included: (1) radial access and drug-eluting stents (DES) over bare-metal stents (BMS) were recommended as a Class I indication, (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. In 2020, updated guidelines for Non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the followings were changed: (1) an early invasive strategy within 24 h is recommended in patients with NSTEMI as a Class I indication, (2) complete revascularization in NSTEMI patients without cardiogenic shock is considered as Class IIa recommendation, and (3) in patients with atrial fibrillation following a short period of triple antithrombotic therapy, dual antithrombotic therapy (e.g., DOAC and single oral antiplatelet agent preferably clopidogrel) is recommended, with discontinuation of the antiplatelet agent after 6 to 12 months. Furthermore, an aspirin-free strategy after PCI has been investigated in several trials those have started to show the safety and efficacy. The Task Force on Primary PCI of the CVIT group has now proposed the updated expert consensus document for the management of AMI focusing on procedural aspects of primary PCI in 2022 version.

Volume‐Outcome Relationships for Percutaneous Coronary Intervention in Acute Myocardial Infarction

“…This was a retrospective study using the DPC administrative database, which does not provide detailed clinical information including laboratory findings, ST‐segment elevation on ECG, and door‐to‐balloon time. The sample size is large to reflect clinical practice for acute MI in Japan, 25 , 26 , 27 , 28 , 29 but there may be residual confounding factors. CIs of the LOWESS were wide, especially in higher volume hospitals (Figure 3 ).…”

Early vascular healing of ultra-thin strut polymer-free sirolimus-eluting stents in acute coronary syndrome: USUI-ACS study

“…PCI was performed according to standard techniques. Radial access is recommended over femoral access [ 7 ]. The direct stenting, thrombectomy, pre-dilatation, and post dilatation were left to each operator’s discretion, and the operator referred to the OCT findings to determine the strategy.…”

Association between Left Ventricular Thrombus Formation and Adverse Outcomes in Acute Anterior Myocardial Infarction Patients who had Undergone Primary Percutaneous Coronary Intervention

“…An INR value of 2 or above was considered normal as per guidelines 11 . A significant bleeding event was characterized as the one with following attributes: intraocular/ intracranial hemorrhage, fall in hemoglobin level by more than 4g/dl, hematoma of greater than 5cm, or the cases who required blood transfusion 12 .…”