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Practice Guideline
. 2024 Oct;39(4):335-375.
doi: 10.1007/s12928-024-01036-y. Epub 2024 Sep 20.

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) in 2024

Yukio Ozaki  1 , Akihiro Tobe  2 , Yoshinobu Onuma  2 , Yoshio Kobayashi  3 , Tetsuya Amano  4 , Takashi Muramatsu  5 , Hideki Ishii  6 , Kyohei Yamaji  7 , Shun Kohsaka  8 , Tevfik F Ismail  9   10 , Shiro Uemura  11 , Yutaka Hikichi  12 , Kenichi Tsujita  13 , Junya Ako  14 , Yoshihiro Morino  15 , Yuichiro Maekawa  16 , Toshiro Shinke  17 , Junya Shite  18 , Yasumi Igarashi  19 , Yoshihisa Nakagawa  20 , Nobuo Shiode  21 , Atsunori Okamura  22 , Takayuki Ogawa  23 , Yoshisato Shibata  24 , Takafumi Tsuji  25 , Kentaro Hayashida  8 , Junji Yajima  26 , Teruyasu Sugano  27 , Hiroyuki Okura  28 , Hideki Okayama  29 , Katsuhiro Kawaguchi  30 , Kan Zen  31 , Saeko Takahashi  32 , Toshihiro Tamura  33 , Kazuhiko Nakazato  34 , Junichi Yamaguchi  35 , Osamu Iida  36 , Reina Ozaki  37 , Fuminobu Yoshimachi  38 , Masaharu Ishihara  39 , Toyoaki Murohara  37 , Takafumi Ueno  40 , Hiroyoshi Yokoi  41 , Masato Nakamura  42 , Yuji Ikari  43 , Patrick W Serruys  2 , Ken Kozuma  44 ; Task Force on Primary Percutaneous Coronary Intervention (PCI) of the Japanese Association of Cardiovascular Intervention, Therapeutics (CVIT)
Affiliations
Practice Guideline

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) in 2024

Yukio Ozaki et al. Cardiovasc Interv Ther. 2024 Oct.

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 Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022. Recently, the European Society of Cardiology (ESC) published the guidelines for the management of acute coronary syndrome in 2023. Major new updates in the 2023 ESC guideline include: (1) intravascular imaging should be considered to guide PCI (Class IIa); (2) timing of complete revascularization; (3) antiplatelet therapy in patient with high-bleeding risk. Reflecting rapid advances in the field, the Task Force on Primary PCI of the CVIT group has now proposed an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2024 version.

Keywords: Acute coronary syndrome (ACS); Non-ST-segment elevation acute coronary syndrome (NSTE-ACS); Non-ST-segment elevation acute myocardial infarction (NSTEMI); Percutaneous coronary intervention (PCI); ST-segment elevation acute my cardial infarction (STEMI).

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Figures

Fig. 1
Fig. 1
The annual number of PCI from 2018 to 2022. The data are based on the J-PCI registry. STEMI ST-segment elevated myocardial infarction; NSTEMI non-ST-segment elevation myocardial infarction; UA unstable angina; CCS chronic coronary syndrome. CCS includes stable angina, asymptomatic ischemia, chronic total occlusion, and staged PCI
Fig. 2
Fig. 2
The annual number of uses of mechanical circulatory support from 2018 to 2022. The data are based on the J-PCI registry. IABP intra-aortic balloon pumping; PCPS percutaneous cardiopulmonary support
Fig. 3
Fig. 3
Summary of recommendations in PCI for ACS. *An immediate invasive (as soon as possible) strategy is recommended in NSTE-ACS patients with very high-risk criteria. An early invasive strategy (within 24 h) should be considered in NSTE-ACS patients with high-risk criteria. †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; NSTE-ACS non-ST-segment elevation acute coronary syndrome; OCT optical coherence tomography; PCI percutaneous coronary intervention; PPI proton pump inhibitor; ST stent thrombosis; STEMI ST-segment elevation myocardial infarction; UFH  unfractionated heparin
See this image and copyright information in PMC

References

    1. Ozaki Y, Katagiri Y, Onuma Y, Amano T, Muramatsu T, Kozuma K, et al. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) in 2018. Cardiovasc Interv Ther. 2018;33(2):178–203. - PMC - PubMed
    1. Ozaki Y, Hara H, Onuma Y, Katagiri Y, Amano T, Kobayashi Y, et al. CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) update 2022. Cardiovasc Interv Ther. 2022;37(1):1–34. - PMC - PubMed
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