Acute Revascularization in ST-Segment-Elevation Myocardial Infarction

Cardiovascular Disease and Stroke (P Perrone-Filardi and S. Agewall, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Cardiovascular Disease and Stroke


We briefly and comprehensively present some of the novel findings in the field of revascularization therapy and management of ST-segment-elevation myocardial infarction (STEMI). We highlight the latest evidence-based advancements in the pharmacological and mechanical treatment of patients who presented with STEMI. Since the last updates to the international guidelines (American College of Cardiology/American Heart Association and the European Society of Cardiology) were published in 2011 and 2012, there have been changes and several important studies have presented their final outcomes. We also highlight some controversial approaches as part of the current debates in the cardiology community. In addition, we share our recent experience in the field of biodegradable scaffold stents as a treatment strategy in STEMI.


Acute revascularization Myocardial infarction Percutaneous coronary intervention Fibrinolysis Antiplatelet therapy Balloon angioplasty Stenting Direct stenting Bioresorbable vascular scaffold Biodegradable stent Multivessel disease Bypass grafting 


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2013. doi:10.1161/01.cir.0000441139.02102.80.PubMedCentralGoogle Scholar
  2. 2.
    Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010;362:2155–65.PubMedCrossRefGoogle Scholar
  3. 3.
    Widimsky P, Wijns W, Fajadet J, de Belder M, Knot J, Aaberge L, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J. 2010;31(8):943–57.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Puymirat E, Simon T, Steg PG, Schiele F, Guéret P, Blanchard D, et al. Association of changes in clinical characteristics and management with improvement in survival among patients with ST-elevation myocardial infarction. JAMA. 2012;308(10):998–1006.PubMedCrossRefGoogle Scholar
  5. 5.
    Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33:2569–619.PubMedCrossRefGoogle Scholar
  6. 6.
    Knot J, Widimsky P, Wijns W, Stenestrand U, Kristensen SD, van’t Hof A, et al. How to set up an effective national primary angioplasty network: lessons learned from five European countries. EuroIntervention. 2009;5(3):299. 301-9.PubMedGoogle Scholar
  7. 7.
    Bagai A, Jollis JG, Dauerman HL, Peng SA, Rokos IC, Bates ER, et al. Emergency department bypass for ST-segment-elevation myocardial infarction patients identified with a prehospital electrocardiogram: a report from the American Heart Association Mission: Lifeline Program. Circulation. 2013;128(4):352–9.PubMedCrossRefGoogle Scholar
  8. 8.
    Concannon TW, Nelson J, Kent DM, Griffith JL. Evidence of systematic duplication by new percutaneous coronary intervention programs. Circ Cardiovasc Qual Outcome. 2013;6(4):400–8.CrossRefGoogle Scholar
  9. 9.
    Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361(9351):13–20.PubMedCrossRefGoogle Scholar
  10. 10.
    Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y, et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013;368(15):1379–87.PubMedCrossRefGoogle Scholar
  11. 11.
    Halvorsen S, Huber K. Fibrinolytic treatment of ST-elevation myocardial infarction. Update 2014. Hamostaseologie. 2013;34(1):47–53.PubMedCrossRefGoogle Scholar
  12. 12.
    Suryapranata H, van't Hof AW, Hoorntje JC, de Boer MJ, Zijlstra F. Randomized comparison of coronary stenting with balloon angioplasty in selected patients with acute myocardial infarction. Circulation. 1998;97(25):2502–5.PubMedCrossRefGoogle Scholar
  13. 13.
    Sasao H, Tsuchihashi K, Nagao K, Miyamoto K, Murakami H, Doi A, et al. Long-term outcome after primary stenting versus balloon angioplasty for acute myocardial infarction five-year follow-up of a case-control study. Int Heart J. 2006;47(1):47–57.PubMedCrossRefGoogle Scholar
  14. 14.
    Möckel M, Vollert J, Lansky AJ, Witzenbichler B, Guagliumi G, Peruga JZ, et al. Comparison of direct stenting with conventional stent implantation in acute myocardial infarction. Am J Cardiol. 2011;108(12):1697–703.PubMedCrossRefGoogle Scholar
  15. 15.
    Loubeyre C, Morice MC, Lefèvre T, Piéchaud JF, Louvard Y, Dumas P. A randomized comparison of direct stenting with conventional stent implantation in selected patients with acute myocardial infarction. Am Coll Cardiol. 2002;39(1):15–21.CrossRefGoogle Scholar
  16. 16.
    Brito Jr FS, Caixeta AM, Perin MA, Rati M, Arruda JA, Cantarelli M, et al. Comparison of direct stenting versus stenting with predilation for the treatment of selected coronary narrowings. Am J Cardiol. 2002;89(2):115–20.PubMedCrossRefGoogle Scholar
  17. 17.
    Palmerini T, Biondi-Zoccai G, Della Riva D, Mariani A, Sabaté M, Valgimigli M, et al. Clinical outcomes with drug-eluting and bare-metal stents in patients with ST-segment elevation myocardial infarction: evidence from a comprehensive network meta-analysis. J Am Coll Cardiol. 2013;62:496–504.PubMedCrossRefGoogle Scholar
  18. 18.
    Garg A, Brodie BR, Stuckey TD, Garberich RF, Tobbia P, Hansen C, et al. New generation drug-eluting stents for ST-Elevation myocardial infarction: a new paradigm for safety. Catheter Cardiovasc Interv. 2013. doi:10.1002/ccd.25280.Google Scholar
  19. 19.
    Park KW, Kang S, Velders MA, Shin D, Hahn S, Lim W, et al. Safety and efficacy of everolimus- versus sirolimus-eluting stents: a systematic review and meta-analysis of 11 randomized trials. Am Heart J. 2013;165:241–50.e4.PubMedCrossRefGoogle Scholar
  20. 20.
    Sabate M, Cequier A, Iñiguez A, Serra A, Hernandez-Antolin R, Mainar V, et al. Everolimus-eluting stent versus bare-metal stent in ST-segment elevation myocardial infarction (EXAMINATION): 1 year results of a randomised controlled trial. Lancet. 2012;380(9852):1482–90.PubMedCrossRefGoogle Scholar
  21. 21.
    Park KW, Lee JM, Kang SH, Ahn HS, Yang HM, Lee HY, et al. Safety and efficacy of second-generation everolimus-eluting Xience V stents versus zotarolimus-eluting resolute stents in real-world practice: patient-related and stent-related outcomes from the multicenter prospective EXCELLENT and RESOLUTE-Korea registries. J Am Coll Cardiol. 2013;61(5):536–44.PubMedCrossRefGoogle Scholar
  22. 22.
    Belardi JA, Widimský P, Neumann FJ, Mauri L, Albertal M. Real-world safety and effectiveness outcomes of a zotarolimus-eluting stent: final 3-year report of the RESOLUTE International study. J Interv Cardiol. 2013;26(5):515–23.PubMedGoogle Scholar
  23. 23.
    Bangalore S, Toklu B, Amoroso N, Fusaro M, Kumar S, Hannan EL, et al. Bare metal stents, durable polymer drug eluting stents, and biodegradable polymer drug eluting stents for coronary artery disease: mixed treatment comparison meta-analysis. BMJ. 2013;347:f6625.PubMedCentralPubMedCrossRefGoogle Scholar
  24. 24.•
    Kocka V, Maly M, Tousek P, Budesínsky T, Lisa L, Prodanov P, et al. Bioresorbable vascular scaffolds in acute ST-segment elevation myocardial infarction: a prospective multicentre study 'Prague 19’. Eur Heart J. 2014. doi:10.1093/eurheartj/eht545. This is the first prospective study testing the use of Biodegradable vascular scaffolds in patients with STEMI. The early outcomes demonstrated in this study are encouraging for the use of BVS in patients with STEMI. Longer follow up will confirm whether these early results are maintained.PubMedCentralPubMedGoogle Scholar
  25. 25.
    Wiebe J, Möllmann H, Most A, Dörr O, Weipert K, Rixe J, et al. Short-term outcome of patients with ST-segment elevation myocardial infarction (STEMI) treated with an everolimus-eluting bioresorbable vascular scaffold. Clin Res Cardiol. 2014;103:141–8.PubMedCrossRefGoogle Scholar
  26. 26.
    O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78–140.PubMedCrossRefGoogle Scholar
  27. 27.••
    Widimsky P, Holmes Jr DR. How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease? Eur Heart J. 2011;32(4):396–403. Until there are published results of clinical trials, this study very comprehensively summarizes the international experience in the field.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Toma M, Buller CE, Westerhout CM, Fu Y, O'Neill WW, Holmes Jr DR, et al. Non-culprit coronary artery percutaneous coronary intervention during acute ST-segment elevation myocardial infarction: insights from the APEX-AMI trial. Eur Heart J. 2010;31(14):1701–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Wald DS, Morris JK, Wald NJ, Chase AJ, Edwards RJ, Hughes LO, et al. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013;369(12):1115–23.PubMedCrossRefGoogle Scholar
  30. 30.
    Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH, et al. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet. 2009;373(9665):723–31.PubMedCrossRefGoogle Scholar
  31. 31.
    Steg PG, James S, Harrington RA, Ardissino D, Becker RC, Cannon CP, et al. Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention: a Platelet Inhibition and Patient Outcomes (PLATO) trial subgroup analysis. Circulation. 2010;122(21):2131–41.PubMedCrossRefGoogle Scholar
  32. 32.
    Valgimigli M, Park SJ, Kim HS, Park KW, Park DW, Tricoci P, et al. Benefits and risks of long-term duration of dual antiplatelet therapy after drug-eluting stenting: a meta-analysis of randomized trials. Int J Cardiol. 2013;168(3):2579–87.PubMedCrossRefGoogle Scholar
  33. 33.
    Desai NR, Bhatt DL. The state of periprocedural antiplatelet therapy after recent trials. J Am Coll Cardiol Interv. 2010;3(6):571–83.CrossRefGoogle Scholar
  34. 34.
    Thiele H, Wöhrle J, Hambrecht R, Rittger H, Birkemeyer R, Lauer B, et al. Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial. Lancet. 2012;379(9819):923–31.PubMedCrossRefGoogle Scholar
  35. 35.
    Shah A, Feldman DN. Outcome of the HORIZONS-AMI trial: bivalirudin enhances long-term survival in patients with ST-elevation myocardial infarction undergoing angioplasty. Vasc Health Risk Manag. 2012;8:115–23.PubMedCentralPubMedGoogle Scholar
  36. 36.
    Bhatt DL, Stone GW, Mahaffey KW, Gibson CM, Steg PG, Hamm CW, et al. Effect of platelet inhibition with cangrelor during PCI on ischemic events. N Engl J Med. 2013;368(14):1303–13.PubMedCrossRefGoogle Scholar
  37. 37.
    Gu YL, van der Horst IC, Douglas YL, Svilaas T, Mariani MA, Zijlstra F. Role of coronary artery bypass grafting during the acute and subacute phase of ST-elevation myocardial infarction. Neth Heart J. 2010;18(7–8):348–54.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Stone GW, Brodie BR, Griffin JJ, Grines L, Boura J, O'Neill WW, et al. Role of cardiac surgery in the hospital phase management of patients treated with primary angioplasty for acute myocardial infarction. Am J Cardiol. 2000;85(11):1292–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Nikolsky E, McLaurin BT, Cox DA, Manoukian SV, Xu K, Mehran R, et al. Outcomes of patients with prior coronary artery bypass grafting and acute coronary syndromes: analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. JACC Cardiovasc Interv. 2012;5(9):919–26.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Cardiocenter, Third Faculty of MedicineCharles University and University Hospital Kralovske VinohradyPrague 10Czech Republic

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