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Review
. 2022 Jan;37(1):1-34.
doi: 10.1007/s12928-021-00829-9. Epub 2022 Jan 12.

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022

Yukio Ozaki  1 , Hironori Hara  2   3 , Yoshinobu Onuma  2 , Yuki Katagiri  4 , Tetsuya Amano  5 , Yoshio Kobayashi  6 , Takashi Muramatsu  7 , Hideki Ishii  8 , Ken Kozuma  9 , Nobuhiro Tanaka  10 , Hitoshi Matsuo  11 , Shiro Uemura  12 , Kazushige Kadota  13 , Yutaka Hikichi  14 , Kenichi Tsujita  15 , Junya Ako  16 , Yoshihisa Nakagawa  17 , Yoshihiro Morino  18 , Ichiro Hamanaka  19 , Nobuo Shiode  20 , Junya Shite  21 , Junko Honye  22 , Tetsuo Matsubara  23 , Kazuya Kawai  24 , Yasumi Igarashi  25 , Atsunori Okamura  26 , Takayuki Ogawa  27 , Yoshisato Shibata  28 , Takafumi Tsuji  29 , Junji Yajima  30 , Kaoru Iwabuchi  31 , Nobuo Komatsu  32 , Teruyasu Sugano  33 , Masaru Yamaki  34 , Shinichiro Yamada  35 , Hiroaki Hirase  36 , Yuusuke Miyashita  37 , Fuminobu Yoshimachi  38 , Masakazu Kobayashi  7 , Jiro Aoki  39 , Hirotaka Oda  40 , Yoshiaki Katahira  41 , Kinzo Ueda  42 , Masami Nishino  43 , Koichi Nakao  44 , Ichiro Michishita  45 , Takafumi Ueno  46 , Taku Inohara  47 , Shun Kohsaka  47 , Tevfik F Ismail  7   48 , Patrick W Serruys  2   49 , Masato Nakamura  50 , Hiroyoshi Yokoi  51 , Yuji Ikari  52 ; Task Force on Primary Percutaneous Coronary Intervention (PCI) of the Japanese Cardiovascular Interventional Therapeutics (CVIT)
Affiliations
Review

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022

Yukio Ozaki et al. Cardiovasc Interv Ther. 2022 Jan.

Abstract

Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST-segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Interventional and Therapeutics (CVIT) society proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018. Updated guidelines for the management of AMI were published by the European Society of Cardiology (ESC) in 2017 and 2020. Major changes in the guidelines for STEMI patients included: (1) radial access and drug-eluting stents (DES) over bare-metal stents (BMS) were recommended as a Class I indication, (2) complete revascularization before hospital discharge (either immediate or staged) is now considered as Class IIa recommendation. In 2020, updated guidelines for Non-ST-Elevation Myocardial Infarction (NSTEMI) patients, the followings were changed: (1) an early invasive strategy within 24 h is recommended in patients with NSTEMI as a Class I indication, (2) complete revascularization in NSTEMI patients without cardiogenic shock is considered as Class IIa recommendation, and (3) in patients with atrial fibrillation following a short period of triple antithrombotic therapy, dual antithrombotic therapy (e.g., DOAC and single oral antiplatelet agent preferably clopidogrel) is recommended, with discontinuation of the antiplatelet agent after 6 to 12 months. Furthermore, an aspirin-free strategy after PCI has been investigated in several trials those have started to show the safety and efficacy. The Task Force on Primary PCI of the CVIT group has now proposed the updated expert consensus document for the management of AMI focusing on procedural aspects of primary PCI in 2022 version.

Keywords: Dual antiplatelet therapy (DAPT); Non-ST-segment elevation acute coronary syndrome (NSTE-ACS); Percutaneous coronary intervention (PCI); ST-segment elevation acute myocardial infarction (STEMI); Thrombus aspiration, Optical coherence tomography (OCT).

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Figures

Fig. 1
Fig. 1
Summary of recommendations in primary PCI. *Urgent coronary angiography (< 2 h) is recommended in very high-risk patients. †Cases with large thrombus formation or plaque burden with a high possibility of distal embolism or slow/no flow; or cases with MI in SVG. DAPT dual antiplatelet therapy; DES drug-eluting stent; GI gastrointestinal; ISR in-stent restenosis; IVUS intravascular ultrasound; NSTEMI non-ST-segment elevation myocardial infarction; OCT optical coherence tomography; PCI percutaneous coronary intervention; PPI proton pump inhibitor; ST stent thrombosis; STEMI ST-segment elevation myocardial infarction; and UFH unfractionated heparin
See this image and copyright information in PMC

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