Revised AHA/ACC PCI and STEMI Guidelines Released

Wednesday at the American Heart Association Scientific Sessions 2009, the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines announced the release of the long-awaited update to the guidelines for management of patients with ST-elevation myocardial infarction (STEMI) and the management of patients undergoing percutaneous coronary intervention (PCI).

efore the initiation of this focused approach,periodic updates and revisions of existing guidelines requiredup to 3 years to complete. Now, however, new evidence will bereviewed in an ongoing fashion to more efficiently respond toimportant science and treatment trends that could have a majorimpact on patient outcomes and quality of care. Evidence willbe reviewed at least twice a year, and updates will be initiatedon an as-needed basis as quickly as possible, while maintainingthe rigorous methodology” for which the ACC and AHA are known.

In an effort to keep pace with new information and insight from clinical research and practice, this “focused update” was created and reviewed using a new approach and methodology that turned what has been a years-long process into one that a little more than a year from start to finish. The preamble of the updated guidelines notes that b

reflect “a consensusof expert opinion after a thorough review primarily of late-breakingclinical trials identified through a broad-based vetting processas being important to the relevant patient population, as wellas a review of other new data deemed to have an impact on patientcare.” Click here to view

schema used for classification of the recommendations and level ofevidence, which also explains “howthe grading system provides an estimate of the size of the treatmenteffect and an estimate of the certainty of the treatment effect.”

The guideline recommendations the

The revised guidelines include recommendations for:

The use of glycoprotein IIb/IIIa receptor antagonists in patients with STEMI

The use of thienopyradines

The use of parenteral anticoagulants

Triage and transfer for PCI

Intensive glucose control in STEMI

Thrombus aspiration during PCI for STEMI

The use of stents in STEMI

Angiography in patients with chronic kidney disease

The use of fractional flow reserve

PCI for unprotected left main coronary artery disease

The timing of angiography and antiplatelet therapy in unstable angina and NSTEMI