ICU Management & Practice, ICU Volume 12 - Issue 3 - Autumn 2012
The European Society of Cardiology (ESC) guidelines for the management of patients with acute ST elevation MI (STEMI) anticipate spurring efforts to improve the speed and efficiency of STEMI care in Europe.
The new recommendations, which were announced at the European Society
of Cardiology 2012 Congress on 26 August, suggest a new standard for time from
medical contact to ECG of 10 minutes. Two hours is the limit of acceptable
delay for a patient transferred from a non-PCI (Percutaneous Coronary Intervention)
centre to a PCI centre, though the target should be 90 minutes, suggest the
guidelines. If PCI within two hours of presentation appears to be impossible,
then fibrinolysis should be administered within 30 minutes, it is recommended.
The guidelines suggest that if fibrinolysis succeeds, angiography can
begin with the expectation of PCI within three to 24 hours. If fibrinolysis
fails, the interventionalist should consider PCI admission as quickly as
possible.
Europe does not yet have a pan-European STEMI registry, but some
countries have national registries, highlighted Dr. Gabriel Steg, chair of the
task force that wrote the new recommendations.
The guidelines recommend implanting drug-eluting instead of
bare-metal stents in patients who are not contraindicated for dual antiplatelet
therapy and are likely to stick to their prescribed regimen. They also advise
newer antiplatelet drugs, such as prasugrel or ticagrelor over clopidogrel.
The document also supports employing
transradial catheterisation rather than the transfemoral approach, but only in
the hands of experienced operators.
Many areas in need of further research are identified in the
guidelines, ranging from questions about early prehospital care to longterm
management.
The new document replaces the guidelines released in 2008 and
complements the non-STEMI treatment guidelines released at last year's ESC
congress.