Author:
Ozaki Yukio,Hara Hironori,Onuma Yoshinobu,Katagiri Yuki,Amano Tetsuya,Kobayashi Yoshio,Muramatsu Takashi,Ishii Hideki,Kozuma Ken,Tanaka Nobuhiro,Matsuo Hitoshi,Uemura Shiro,Kadota Kazushige,Hikichi Yutaka,Tsujita Kenichi,Ako Junya,Nakagawa Yoshihisa,Morino Yoshihiro,Hamanaka Ichiro,Shiode Nobuo,Shite Junya,Honye Junko,Matsubara Tetsuo,Kawai Kazuya,Igarashi Yasumi,Okamura Atsunori,Ogawa Takayuki,Shibata Yoshisato,Tsuji Takafumi,Yajima Junji,Iwabuchi Kaoru,Komatsu Nobuo,Sugano Teruyasu,Yamaki Masaru,Yamada Shinichiro,Hirase Hiroaki,Miyashita Yuusuke,Yoshimachi Fuminobu,Kobayashi Masakazu,Aoki Jiro,Oda Hirotaka,Katahira Yoshiaki,Ueda Kinzo,Nishino Masami,Nakao Koichi,Michishita Ichiro,Ueno Takafumi,Inohara Taku,Kohsaka Shun,Ismail Tevfik F.,Serruys Patrick W.,Nakamura Masato,Yokoi Hiroyoshi,Ikari Yuji,
Abstract
AbstractPrimary 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.
Publisher
Springer Science and Business Media LLC
Subject
Cardiology and Cardiovascular Medicine,Radiology, Nuclear Medicine and imaging,General Medicine