Percutaneous coronary intervention ST-elevation myocardial infarction (STEMI)

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Overview

PCI Approaches:

CAD Revascularization:

Heart Team Approach to Revascularization Decisions
Left Main Coronary Artery Disease
Intervention in left main coronary artery disease
Non-Left Main Coronary Artery Disease
Revascularization to Improve Symptoms
Dual Antiplatelet Therapy Compliance and Stent Thrombosis
Hybrid Coronary Revascularization

Pre-procedural Considerations:

Contrast-Induced Acute Kidney Injury
Anaphylactoid Reactions
Statin Treatment
Bleeding Risk
Role of Onsite Surgical Backup

Procedural Considerations:

Vascular Access
PCI in Specific Clinical Situations:
Asymptomatic Ischemia or CCS Class I or II Angina
CCS Class III Angina
Unstable Angina/Non–ST-Elevation Myocardial Infarction
ST-Elevation Myocardial Infarction:
General and Specific Considerations
Coronary Angiography Strategies in STEMI
Primary PCI of the Infarct Artery
Delayed or Elective PCI in patients with STEMI
Fibrinolytic-Ineligible Patients
Facilitated PCI
Rescue PCI
After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion
Cardiogenic Shock
Prior Coronary Bypass Surgery
Revascularization Before Non-cardiac Surgery
Adjunctive Diagnostic Devices:
Fractional Flow Reserve
Intravascular Ultrasound
Adjunctive Therapeutic Devices:
Coronary Atherectomy
Thrombectomy
Laser Angioplasty
Cutting Balloon Angioplasty
Embolic Protection Devices
Percutaneous Hemodynamic Support Devices
Antiplatelet therapy:
Oral Antiplatelet Therapy
Glycoprotein IIb/IIIa Receptor Antagonists
Intravenous Antiplatelet therapy:
STEMI
UA/NSTEMI
SIHD
Anticoagulant Therapy:
Parenteral Anticoagulants During PCI
Unfractionated Heparin
Enoxaparin
Bivalirudin and Argatroban
Fondaparinux
No-Reflow Pharmacological Therapies
PCI in Specific Anatomic Situations:
Chronic Total Occlusions
Saphenous Vein Grafts
Bifurcation Lesions
Aorto-Ostial Stenoses
Calcified Lesions
PCI in Specific Patient Populations:
Chronic Kidney Disease
Peri-procedural Myocardial Infarction Assessment
Vascular Closure Devices

Post-Procedural Considerations:

Post-procedural Antiplatelet Therapy
Proton Pump Inhibitors and Antiplatelet Therapy
Clopidogrel Genetic Testing
Platelet Function Testing
Restenosis
Exercise Testing
Cardiac Rehabilitation

Quality and Performance Considerations:

Quality and Performance
Certification and Maintenance of Certification
Operator and Institutional Competency and Volume

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention (DO NOT EDIT)[1]

Intravenous Antiplatelet Therapy in patients of ST-Elevation Myocardial Infarction (STEMI) (DO NOT EDIT)[1]

Class III (No Benefit)
"1. Routine pre-catheterization laboratory (e.g., ambulance or emergency room) administration of glycoprotein IIb/IIIa inhibitors as part of an upstream strategy for patients with STEMI undergoing PCI is not beneficial.[2][3][4][5][6][7][8][9] (Level of Evidence: B)"
Class IIa
"1. In patients undergoing primary PCI treated with unfractionated heparin (UFH), it is reasonable to administer a glycoprotein IIb/IIIa inhibitor (abciximab, double-bolus eptifibatide, or high-bolus dose tirofiban), whether or not patients were pretreated with clopidogrel.[10][11][12][13][14][15][16] (For glycoprotein IIb/IIIa inhibitor administration in patients not pretreated with clopidogrel, (Level of Evidence: A); for glycoprotein IIb/IIIa inhibitor administration in patients pretreated with clopidogrel,(Level of Evidence: C))"
Class IIb
"1. In patients undergoing primary PCI with abciximab, it may be reasonable to administer intracoronary abciximab.[15][17][18][19][20][21][22][23][24][25][26][27][28][29][30] (Level of Evidence: B)"

References

  1. ↑ 1.0 1.1 Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH (2011). "2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions" (PDF). Journal of the American College of Cardiology. 58 (24): 2550–83. doi:10.1016/j.jacc.2011.08.006. PMID 22070837. Retrieved 2011-12-08. Text "PDF" ignored (help); Unknown parameter |month= ignored (help)
  2. ↑ Montalescot G, Borentain M, Payot L, Collet JP, Thomas D (2004). "Early vs late administration of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction: a meta-analysis". JAMA : the Journal of the American Medical Association. 292 (3): 362–6. doi:10.1001/jama.292.3.362. PMID 15265852. Retrieved 2011-12-12. Unknown parameter |month= ignored (help)
  3. ↑ Maioli M, Bellandi F, Leoncini M, Toso A, Dabizzi RP (2007). "Randomized early versus late abciximab in acute myocardial infarction treated with primary coronary intervention (RELAx-AMI Trial)". Journal of the American College of Cardiology. 49 (14): 1517–24. doi:10.1016/j.jacc.2006.12.036. PMID 17418289. Retrieved 2011-12-12. Unknown parameter |month= ignored (help)
  4. ↑ Keeley EC, Boura JA, Grines CL (2006). "Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials". Lancet. 367 (9510): 579–88. doi:10.1016/S0140-6736(06)68148-8. PMID 16488801. Retrieved 2011-12-12. Unknown parameter |month= ignored (help)
  5. ↑ Van't Hof AW, Ten Berg J, Heestermans T, Dill T, Funck RC, van Werkum W, Dambrink JH, Suryapranata H, van Houwelingen G, Ottervanger JP, Stella P, Giannitsis E, Hamm C (2008). "Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial". Lancet. 372 (9638): 537–46. doi:10.1016/S0140-6736(08)61235-0. PMID 18707985. Retrieved 2011-12-12. Unknown parameter |month= ignored (help)
  6. ↑ ten Berg JM, van 't Hof AW, Dill T, Heestermans T, van Werkum JW, Mosterd A, van Houwelingen G, Koopmans PC, Stella PR, Boersma E, Hamm C (2010). "Effect of early, pre-hospital initiation of high bolus dose tirofiban in patients with ST-segment elevation myocardial infarction on short- and long-term clinical outcome". Journal of the American College of Cardiology. 55 (22): 2446–55. doi:10.1016/j.jacc.2009.11.091. PMID 20510211. Retrieved 2011-12-12. Unknown parameter |month= ignored (help)
  7. ↑ Ellis SG, Tendera M, de Belder MA, van Boven AJ, Widimsky P, Andersen HR, Betriu A, Savonitto S, Adamus J, Peruga JZ, Hamankiewicz M, Pluta W, Oldroyd K, Ecollan P, Janssens L, Armstrong P, Brodie BR, Herrmann HC, Montalescot G, Neumann FJ, Effron MB, Barnathan ES, Topol EJ (2009). "1-year survival in a randomized trial of facilitated reperfusion: results from the FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) trial". JACC. Cardiovascular Interventions. 2 (10): 909–16. doi:10.1016/j.jcin.2009.07.009. PMID 19850248. Retrieved 2011-12-12. Unknown parameter |month= ignored (help)
  8. ↑ Ellis SG, Tendera M, de Belder MA, van Boven AJ, Widimsky P, Janssens L, Andersen HR, Betriu A, Savonitto S, Adamus J, Peruga JZ, Kosmider M, Katz O, Neunteufl T, Jorgova J, Dorobantu M, Grinfeld L, Armstrong P, Brodie BR, Herrmann HC, Montalescot G, Neumann FJ, Effron MB, Barnathan ES, Topol EJ (2008). "Facilitated PCI in patients with ST-elevation myocardial infarction". The New England Journal of Medicine. 358 (21): 2205–17. doi:10.1056/NEJMoa0706816. PMID 18499565. Retrieved 2011-12-12. Unknown parameter |month= ignored (help)
  9. ↑ El Khoury C, Dubien PY, Mercier C, Belle L, Debaty G, Capel O, Perret T, Savary D, Serre P, Bonnefoy E (2010). "Prehospital high-dose tirofiban in patients undergoing primary percutaneous intervention. The AGIR-2 study". Archives of Cardiovascular Diseases. 103 (5): 285–92. doi:10.1016/j.acvd.2010.04.005. PMID 20619238. Retrieved 2011-12-12. Unknown parameter |month= ignored (help)
  10. ↑ Antoniucci D, Migliorini A, Parodi G, Valenti R, Rodriguez A, Hempel A, Memisha G, Santoro GM (2004). "Abciximab-supported infarct artery stent implantation for acute myocardial infarction and long-term survival: a prospective, multicenter, randomized trial comparing infarct artery stenting plus abciximab with stenting alone". Circulation. 109 (14): 1704–6. doi:10.1161/01.CIR.0000126284.40075.98. PMID 15066943. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  11. ↑ Neumann FJ, Kastrati A, Schmitt C, Blasini R, Hadamitzky M, Mehilli J, Gawaz M, Schleef M, Seyfarth M, Dirschinger J, Schömig A (2000). "Effect of glycoprotein IIb/IIIa receptor blockade with abciximab on clinical and angiographic restenosis rate after the placement of coronary stents following acute myocardial infarction". Journal of the American College of Cardiology. 35 (4): 915–21. PMID 10732888. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  12. ↑ Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Carroll JD, Rutherford BD, Lansky AJ (2002). "Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction". The New England Journal of Medicine. 346 (13): 957–66. doi:10.1056/NEJMoa013404. PMID 11919304. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  13. ↑ Montalescot G, Barragan P, Wittenberg O, Ecollan P, Elhadad S, Villain P, Boulenc JM, Morice MC, Maillard L, Pansiéri M, Choussat R, Pinton P (2001). "Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction". The New England Journal of Medicine. 344 (25): 1895–903. doi:10.1056/NEJM200106213442503. PMID 11419426. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  14. ↑ De Luca G, Suryapranata H, Stone GW, Antoniucci D, Tcheng JE, Neumann FJ, Van de Werf F, Antman EM, Topol EJ (2005). "Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: a meta-analysis of randomized trials". JAMA : the Journal of the American Medical Association. 293 (14): 1759–65. doi:10.1001/jama.293.14.1759. PMID 15827315. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  15. ↑ 15.0 15.1 Mehilli J, Kastrati A, Schulz S, Früngel S, Nekolla SG, Moshage W, Dotzer F, Huber K, Pache J, Dirschinger J, Seyfarth M, Martinoff S, Schwaiger M, Schömig A (2009). "Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention after clopidogrel loading: a randomized double-blind trial". Circulation. 119 (14): 1933–40. doi:10.1161/CIRCULATIONAHA.108.818617. PMID 19332467. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  16. ↑ De Luca G, Navarese E, Marino P (2009). "Risk profile and benefits from Gp IIb-IIIa inhibitors among patients with ST-segment elevation myocardial infarction treated with primary angioplasty: a meta-regression analysis of randomized trials". European Heart Journal. 30 (22): 2705–13. doi:10.1093/eurheartj/ehp118. PMC 2777025. PMID 19875386. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  17. ↑ Bellandi F, Maioli M, Gallopin M, Toso A, Dabizzi RP (2004). "Increase of myocardial salvage and left ventricular function recovery with intracoronary abciximab downstream of the coronary occlusion in patients with acute myocardial infarction treated with primary coronary intervention". Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions. 62 (2): 186–92. doi:10.1002/ccd.20041. PMID 15170708. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  18. ↑ Romagnoli E, Burzotta F, Trani C, Mazzari MA, Biondi-Zoccai GG, De Vita M, Giannico F, Niccoli G, Prati F, Rebuzzi AG, Mongiardo R, Crea F (2005). "Angiographic evaluation of the effect of intracoronary abciximab administration in patients undergoing urgent PCI". International Journal of Cardiology. 105 (3): 250–5. doi:10.1016/j.ijcard.2004.11.037. PMID 16274764. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  19. ↑ Iversen A, Galatius S, Jensen JS (2008). "The Optimal Route of Administration of the Glycoprotein IIb/IIIa Receptor Antagonist Abciximab During Percutaneous Coronary Intervention; Intravenous Versus Intracoronary". Current Cardiology Reviews. 4 (4): 293–9. doi:10.2174/157340308786349480. PMC 2801861. PMID 20066137. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  20. ↑ Wöhrle J, Nusser T, Mayer C, Kochs M, Hombach V (2008). "Intracoronary application of abciximab in patients with ST-elevation myocardial infarction". EuroIntervention : Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 3 (4): 465–9. PMID 19736089. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  21. ↑ Kakkar AK, Moustapha A, Hanley HG, Weiss M, Caldito G, Misra P, Reddy PC, Tandon N (2004). "Comparison of intracoronary vs. intravenous administration of abciximab in coronary stenting". Catheterization and Cardiovascular Interventions :Official Journal of the Society for Cardiac Angiography & Interventions. 61 (1): 31–4. doi:10.1002/ccd.10730. PMID 14696156. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  22. ↑ Bertrand OF, Rodés-Cabau J, Larose E, Rinfret S, Gaudreault V, Proulx G, Barbeau G, Déry JP, Gleeton O, Manh-Nguyen C, Noël B, Roy L, Costerousse O, De Larochellière R (2010). "Intracoronary compared to intravenous Abciximab and high-dose bolus compared to standard dose in patients with ST-segment elevation myocardial infarction undergoing transradial primary percutaneous coronary intervention: a two-by-two factorial placebo-controlled randomized study". The American Journal of Cardiology. 105 (11): 1520–7. doi:10.1016/j.amjcard.2010.01.006. PMID 20494655. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  23. ↑ Wöhrle J, Grebe OC, Nusser T, Al-Khayer E, Schaible S, Kochs M, Hombach V, Höher M (2003). "Reduction of major adverse cardiac events with intracoronary compared with intravenous bolus application of abciximab in patients with acute myocardial infarction or unstable angina undergoing coronary angioplasty". Circulation. 107 (14): 1840–3. doi:10.1161/01.CIR.0000066852.98038.D1. PMID 12682003. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  24. ↑ Deibele AJ, Kirtane AJ, Pinto DS, Lucca MJ, Neva C, Shui A, Murphy SA, Tcheng JE, Gibson CM (2006). "Intracoronary bolus administration of eptifibatide during percutaneous coronary stenting for non ST elevation myocardial infarction and unstable angina". Journal of Thrombosis and Thrombolysis. 22 (1): 47–50. doi:10.1007/s11239-006-7454-8. PMID 16786232. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  25. ↑ Yang XC, Zhang DP, Wang LF, Xu L, Ge YG, Wang HS, Li WM, Ni ZH, Xia K, Lian Y, Xue YL, Ma LX (2007). "[Effects of intracoronary or intravenous tirofiban administration in patients with acute ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention]". Zhonghua Xin Xue Guan Bing Za Zhi (in Chinese). 35 (6): 517–22. PMID 17711710. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  26. ↑ Hansen PR, Iversen A, Abdulla J (2010). "Improved clinical outcomes with intracoronary compared to intravenous abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention: a systematic review and meta-analysis". The Journal of Invasive Cardiology. 22 (6): 278–82. PMID 20516508. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  27. ↑ Galache Osuna JG, Sánchez-Rubio J, Calvo I, Diarte JA, Lukic A, Placer LJ (2006). "[Does intracoronary abciximab improve the outcome of percutaneous coronary interventions? A randomized controlled trial]". Revista Española De Cardiología (in Spanish; Castilian). 59 (6): 567–74. PMID 16790200. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  28. ↑ Wu TG, Zhao Q, Huang WG, Wei JR, Chen SW, Zhao J, Huang LP, Wang LX (2008). "Effect of intracoronary tirofiban in patients undergoing percutaneous coronary intervention for acute coronary syndrome". Circulation Journal : Official Journal of the Japanese Circulation Society. 72 (10): 1605–9. PMID 18753700. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)
  29. ↑ Marciniak SJ, Mascelli MA, Furman MI, Michelson AD, Jakubowski JA, Jordan RE, Marchese PJ, Frelinger AL (2002). "An additional mechanism of action of abciximab: dispersal of newly formed platelet aggregates". Thrombosis and Haemostasis. 87 (6): 1020–5. PMID 12083481. Unknown parameter |month= ignored (help); |access-date= requires |url= (help)
  30. ↑ Deibele AJ, Jennings LK, Tcheng JE, Neva C, Earhart AD, Gibson CM (2010). "Intracoronary eptifibatide bolus administration during percutaneous coronary revascularization for acute coronary syndromes with evaluation of platelet glycoprotein IIb/IIIa receptor occupancy and platelet function: the Intracoronary Eptifibatide (ICE) Trial". Circulation. 121 (6): 784–91. doi:10.1161/CIRCULATIONAHA.109.882746. PMID 20124127. Retrieved 2011-12-14. Unknown parameter |month= ignored (help)

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