[Acute myocardial infarction in patients with ST-segment elevation myocardial infarction : ESC guidelines 2017]

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• The management of ST-segment elevation myocardial infarction (STEMI) has evolved since the 2012 European Society of Cardiology (ESC) guidelines.
• Recent advancements necessitate an update to reflect current best practices and evidence.

Purpose of the Study:

• To provide an update on acute STEMI management based on the 2017 ESC guidelines.
• To compare the modifications introduced in the 2017 guidelines with the previous 2012 STEMI guidelines.

Main Methods:

• Review and synthesis of the 2017 ESC guidelines for STEMI management.
• Comparative analysis of key recommendations between the 2017 and 2012 STEMI guidelines.

Main Results:

• Primary percutaneous coronary intervention (PCI) remains the preferred reperfusion strategy.
• New recommendations favor radial artery access, drug-eluting stents, complete revascularization, and avoidance of routine thrombus aspiration.
• Bivalirudin is downgraded for periprocedural anticoagulation during PCI; oxygen is recommended only for saturation <90%.
• Intra-aortic balloon pumps are no longer recommended for cardiogenic shock.
• Updated guidance on dual antiplatelet therapy duration and new sections on myocardial infarction with no obstructive coronary artery disease (MINOCA) are introduced.

Conclusions:

• The 2017 ESC guidelines refine STEMI management, emphasizing updated reperfusion strategies and device choices.
• New recommendations aim to optimize patient outcomes, including specific guidance on anticoagulation, oxygen use, and dual antiplatelet therapy duration.
• The guidelines incorporate novel aspects like MINOCA and quality indicators for STEMI networks.