SCAI consensus statement offers technical guidance for PCI in patients with STEMI
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Key takeaways:
- SCAI has released a consensus statement on management of the technical aspects of PCI for patients with STEMI.
- The statement also covers how to manage unusual situations in this population.
The Society for Cardiovascular Angiography and Interventions has released a consensus statement on how catheterization laboratories should manage the technical aspects of PCI for patients with STEMI.
“There are different approaches to managing patients with STEMI in the cath lab and the guidelines do not generally discuss the technical management of such patients,” Jacqueline E. Tamis-Holland, MD, FSCAI, interventional cardiologist and Institute Director for Acute Coronary Care in the Section of Invasive and Interventional Cardiology of The Tomsich Family Department of Cardiovascular Medicine, Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic, and chair of the writing committee, told Healio. “There are nuances in care and we must individualize care in many cases. For this reason, we felt this document was needed to discuss and highlight best practices for technical approach to treating these patients and how to manage unusual circumstances as well.”
When a patient presents with STEMI, “coordinated team based evaluations should rapidly triage patients to the cath lab, while providing focused care to ensure safe and appropriate treatment,” Tamis-Holland said.
The statement, which was published in the Journal of the Society for Cardiovascular Angiography and Interventions, recommends transradial access be used in PCI for patients with STEMI, but if transfemoral access is required, techniques such as routine ultrasound and fluoroscopy should be employed.
Patients should receive a complete diagnostic angiogram, and routine use of intracoronary imaging to guide PCI is encouraged, Tamis-Holland and colleagues wrote, noting that intracoronary imaging should be employed if there is stent thrombosis or stent failure, and that it is helpful in investigating nonatherosclerotic causes of STEMI.
“Many patients with STEMI do not fall under the usual care, including those with shock, SCAD (spontaneous coronary artery dissection), MINOCA (MI with no obstructed coronary arteries) and embolism, and one might need to approach these patients differently,” Tamis-Holland told Healio.
Several recommendations concern alleviating thrombus burden and establishing reflow.
“Managing thrombus and no reflow are the Achilles’ heel for treating STEMI, and considerations need to be made based on thrombus burden, extent of no-reflow and clinical features,” she said.
The document also calls for complete revascularization with treatments of stenoses that did not cause the infarct in patients with STEMI and multivessel disease and for right heart catheterization to be performed in patients with STEMI and cardiogenic shock.
If MINOCA is suspected, additional investigations should be launched to identify the etiology and rule out conditions that mimic MINOCA. These tools can include left ventriculogram, intracoronary imaging, cardiac MRI, and/or coronary microvascular dysfunction testing, the authors wrote.
To enhance quality of care, the statement recommends that each institution/health care system track each STEMI case to assess time to treatment and outcomes.
For more information:
Jacqueline E. Tamis-Holland, MD, FSCAI, can be reached at tamisj@ccf.org.
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Tamis-Holland JE, et al. J Soc Cardiovasc Angiogr Interv. 2024;doi:10.1016/j.jscai.2024.102294.
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