ST-elevation myocardial infarction

New US guideline on coronary artery revascularization recommends a shorter 1- to 3-month duration of dual antiplatelet therapy after percutaneous coronary intervention in select patients

A new guideline on coronary artery revascularization has been published by the American Heart Association and American College of Cardiology in partnership with the Society for Cardiovascular Angiography. Key recommendations include:

• A shorter 1- to 3-month duration of dual antiplatelet therapy (DAPT) following percutaneous coronary intervention (PCI) for selected patients, with subsequent transition to P2Y12 inhibitor monotherapy, to reduce the risk of bleeding events. Previously, DAPT was recommended for 6 to 12 months following PCI.

• For hospitals without catheterization laboratories, consider routine transfer to a PCI facility for all hemodynamically stable patients if transfer times are reasonable and total ischemic time after presentation is less than 120 minutes.

• Coronary artery bypass graft (CABG) should not be undertaken after failed primary PCI in the absence of ischemia or a large area of myocardium at risk, or if surgical revascularization is not feasible due to a no-reflow state or poor distal targets.

• Use a patient-centered shared decision-making process for patients with ST-elevation myocardial infarction for whom the optimal coronary revascularization strategy is not clear (e.g., if there is complex coronary disease and/or comorbid conditions). This should utilize a multidisciplinary team that includes representatives from interventional cardiology, cardiac surgery, and clinical cardiology.

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See Management: treatment algorithm

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