New ESC Guidelines Provide Insight into ST-Segment Elevation Management
The new ESC guidelines include recently published clinical data on the treatment strategies for the various complications after STEMI.
The task force for the management of acute myocardial infarction (AMI) in patients presenting with ST-segment elevation (STE) of the European Society of Cardiology (ESC) has provided their 2017 guidelines regarding treatment strategies for AMI and STEMI, including summaries of recent clinical data regarding reperfusion therapy, risk factor control and lifestyle interventions, fibrinolysis and pharmacoinvasive strategies, and antithrombotic therapy, among other treatment modalities. These new guidelines were published in the European Heart Journal.
The 2017 ESC guidelines include recently published clinical data on the treatment strategies for the various complications after STEMI, including heart failure, myocardial dysfunction, cardiogenic shock, and hypotension. Based on expert opinion, the new guidelines also now recommend complete revascularization during an index primary percutaneous coronary intervention in patients with STEMI who are also in shock. In addition, the task force now recommends the extension of ticagrelor for up to 36 months for high-risk patients on the basis of the PEGASUS-TIMI 54 clinical trial results.
The guidelines also cited a need for more pragmatic real-life clinical trials as well as greater observational data for understanding common treatment challenges in clinical practice. Further research may be necessary for left ventricular assist devices and myocardial repair/rescue, as well as the effects of beta-blockers and angiotensin-converting enzyme inhibitors, according to the task force.
Task force investigators commented that there is currently "a wide practice gap between optimal and actual care for patients with STEMI in hospitals around the world." One of the suggestions for reducing this gap is for STEMI networks to "establish measurable quality indicators, systems to measure and compare these indicators...and implement strategies to ensure that every patient with STEMI receives the best possible care."
Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) [published online August 26, 2017]. Eur Heart J. doi:10.1093/eurheartj/ehx393