IN A NEW expert consensus statement, the Society for Cardiovascular Angiography & Interventions (SCAI) has presented detailed guidance to help interventional cardiologists optimise primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) in the cardiac catheterisation lab (CCL).
This framework complements broader European Society of Cardiology (ESC) guidelines on acute coronary syndrome but focuses on practical, procedural recommendations essential for high-quality STEMI care.
One key recommendation is prioritising a “transradial-first” approach for arterial access in PCI, a strategy associated with reduced mortality and bleeding risks. A meta-analysis of 21,600 patients highlighted that radial access, compared to femoral access, lowered mortality by nearly 24% and major bleeding by 45%. The approach has grown significantly in popularity, rising from 23.9% use in 2013 to 68.2% by 2022.
For cases necessitating femoral access, the authors recommend ultrasound guidance to minimise complications. Data from a study of 2,441 patients showed ultrasound guidance reduced major vascular complications and bleeding by 39%, underscoring the importance of training CCL staff to routinely incorporate ultrasound equipment for transfemoral access procedures.
The report also emphasises the role of intravascular imaging (IVI) in PCI, especially for complex coronary lesions, to ensure effective stent deployment and minimise future complications. The recent IVUS-ACS trial supported this recommendation, revealing a nearly 45% reduction in target vessel failure in patients treated with IVI-guided PCI.
In managing patients with advanced cardiogenic shock, the use of microaxial flow pumps and right heart catheterisation for circulatory support were advised, supported by findings from the DanGer Shock trial that showed reduced 180-day mortality.
For patients with multivessel disease, the authors encourage complete revascularisation of non-culprit lesions, which has been shown to decrease cardiovascular death or myocardial infarction by 26%.
Finally, the authors identified evidence gaps, including the need for large randomised trials testing newer mechanical thrombectomy devices, which may reduce risk of thrombus embolization and stroke. Overall, this consensus statement serves as a practical framework to standardise CCL practices and enhance patient outcomes in STEMI management.
Reference
Tamis-Holland JE et al. SCAI expert consensus statement on the management of patients with STEMI referred for primary PCI. JSCAI. 2024; DOI:10.1016/j.jscai.2024.102294.
