Update to Guidelines on Percutaneous Coronary Intervention and treatment of ST-Segment Elevation Myocardial Infarction (2015)
In the last five years, key guidelines have been published regarding the use of percutaneous coronary intervention (PCI) in patients who have suffered heart attacks. In 2011, the American College of Cardiology, American Heart Association and Society for Cardiovascular Angiography and Interventions released a guideline for PCI – a minimally invasive procedure used to treat narrowed or blocked coronary arteries. And in 2013, the American College of Cardiology and American Heart Association released a guideline for the treatment of a ST-elevation myocardial infarction (STEMI), which is a heart attack where a major coronary artery is completely blocked.
Both guidelines addressed the use of PCI in patients with STEMI heart attacks, as PCI helps restore blood flow and minimize damage to the heart. However, experts recently made a few key changes to these guidelines based on the latest findings.
The first change is regarding the use of PCI in multiple blocked vessels. When patients receive PCI for treatment of a heart attack, the goal is to restore blood flow in the blocked vessel. But since many heart attack patients have blockages in multiple arteries, patients undergoing PCI may receive treatment in more than one vessel. Previous guidelines recommended against such treatment in patients with STEMI, because it was believed that the risks outweighed the benefits at the time. However, new research suggests that using PCI to treat multiple vessels may be beneficial for some STEMI patients. And according to recent updates, this treatment may now be considered but should not be endorsed as routine practice.
The second key update is regarding a procedure used to remove blood clots, called aspiration thrombectomy. The 2011 and 2013 guidelines recommended routine use of this procedure before PCI. At the time, research suggested that this procedure was both effective and beneficial for STEMI patients. However, further analysis of research now suggests aspiration thrombectomy before PCI can cause complications in certain patients. As such, experts now advise against using this procedure routinely in patients undergoing PCI as its usefulness is not well established.
For complete guidelines on PCI and STEMI treatment, please click below:
2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction
Read the full update to these guidelines in the Journal of the American College of Cardiology