Abstrakt
Three different guidelines of the European Society of Cardiology (ESC) cover the field of percutaneous coronary interventions (PCI). Their main recommendations are the following: All patients with ST-segment elevation myocardial infarction (STEMI) should undergo immediate coronary angiography and PCI as soon as possible after first medical contact.
Thrombolysis can be used as alternative reperfusion therapy only for patients presenting early (<3 h from symptom onset) with expected time to PCI longer than 60-90 min. Patients with high risk non-ST-segment elevation (NSTE) acute coronary syndromes (ACS) (recurrent or ongoing chest pain, profound or dynamic ECG changes, major arrhythmias, or haemodynamic instability) should undergo coronary angiography within <2 h after the initial hospital admission.
Moderate risk NSTE ACS patients should undergo coronary angiography within <3 days after the initial hospital admission. Low risk NSTE ACS patients may be treated conservatively and the decision on invasive evaluation can be based on evidence of ischaemia during exercise stress testing.
Stents should be used during all PCI procedures whenever technically feasible. Drug-eluting stents decrease the risk of restenosis, but do not influence mortality when compared with bare metal stents.
Triple pharmacotherapy (most frequently aspirin, clopidogrel, and heparin or their therapeutic equivalents) should be used in all PCI procedures, with GPIIb/IIIa inhibitors added in patients with high thrombotic and low bleeding risk.