Fast PCI First Choice for STEMI
For patients with ST-segment-elevation MI (STEMI), percutaneous coronary intervention (PCI) is the treatment of choice, as long as it can be done in time, according to a new guideline.
Balloon angioplasty and stenting is preferred when patients have had STEMI symptoms for less than 12 hours, though the strategy can also be applied to those having symptoms for up to 24 hours, according to Patrick O'Gara, MD, of Brigham and Women's Hospital in Boston, and colleagues.
O'Gara was the chair of the writing committee for the updated STEMI guidelines, which were last published in 2004 with updates in 2007 and 2009.
The newest guideline was published online in Circulation: Journal of the American Heart Association and the Journal of the American College of Cardiology.
O'Gara and colleagues noted that the guideline is narrower in scope than the 2004 version in order to provide a more focused tool for clinicians.
Clinicians should use either a bare-metal or drug-eluting stent when STEMI patients need more than just balloon angioplasty, though bare-metal is preferred for those with a high risk of bleeding or if they can't comply with a year-long course of dual antiplatelet therapy (DAPT), according to the guidelines.