Manual of STEMI Interventions

Sameer Mehta

• Publisher: Wiley-Blackwell
• Year: 2017
• Print ISBN: 9781119095415
• eBook ISBN: 9781119095422
• Edition: 1
• Topic: Medicine
• Subtopic: Cardiology

Benefit from this concise yet comprehensive manual, designed to improve the practice and process of STEMI interventions

• Understand the varied pharmacological options available in managing STEMI patients, including newer anti-coagulants   
• Improve your STEMI procedure technique through expert guidance, including stent choice, and other techniques such as trans radial procedures 
• Provides an overview of STEMI networks internationally and how to set up a STEMI program
• Reviews future perspectives for STEMI and the role of telemedicine for STEMI procedures

Part I
Guidelines, Thrombolytic Therapy, Pharmacology

1
Compendium of STEMI Clinical Trials

Juanita Gonzalez Arango MD, Miguel Vega Arango MD, Estefania Calle Botero MD, Isaac Yepes Moreno MD, Maria Botero Urrea MD, Alicia Henao Velasquez MD, Daniel Rodriguez MD, Daniela Parra Dunoyer MD, Maria Teresa Bedoya Reina MD, Sameer Mehta MD

Introduction

As we constructed our fourth textbook of interventions for ST‐elevation myocardial infarction (STEMI), the need for including a chapter on clinical trials was paramount. To provide a complete compendium of relevant STEMI guidelines and clinical trials, two distinct chapters have been created. We recognize that this information is easily obtained from searching the internet; however, we deemed it important to present in this book the most up‐to‐date guidelines and clinical trials. In this chapter, we have divided the trials into stents (Table 1.1), no‐reflow (Table 1.2), thrombectomy (Table 1.3), percutaneous coronary interventions for non‐culprit lesions (Table 1.4), and the role of left ventricular support devices (Table 1.5). In Chapter 2, we have separated out those guidelines from the American College of Cardiology and the European Society of Cardiology. These topics are discussed further in various chapters of the textbook. However, we firmly believe that a compendium of guidelines and clinical trials will provide a useful summary of these STEMI‐related studies.

Table 1.1 Which stent is most desirable for STEMI interventions?

Study Title	Hypothesis	Cohort	Principal Findings	Conclusion
COBALT: long‐term clinical outcome of thin‐strut CoCr stents in the DES era [1].	To assess characteristics and outcomes of patients treated with 2 different new‐generation CoCr BMS, the MULTI‐LINK VISION^® and PRO‐Kinetic Energy^® stents.	1176 patients: MLV (n = 438); PRO‐Kinetic (n = 738).	TLR and TVR were lower in the MLV group. Death, MI, ARC and definite stent thrombosis were similar.	The use of last‐generation thin‐strut BMS in selected patients is associated with acceptable clinical outcome, with similar clinical results for both the MLV and PRO‐Kinetic stents.
Comparison of newer‐generation DES with BMS in patients with acute STEMI [2].	Efficacy and safety of newer‐generation DES compared with BMS in patients with STEMI.	2665 STEMI patients: 1326 received a newer‐generation DES (EES or biolimus A9 eluting stent) and 1329 received BMS.	Newer‐generation DES substantially reduced the risk of repeat TVR, target‐vessel infarction, definite stent thrombosis compared with BMS at 1 year.	Newer‐generation DES improves safety and efficacy compared with BMS throughout 1st year.
Meta‐analysis of long‐term outcomes for DES compared with BMS in PCI for STEMI [3].	Available literature examining the outcomes of DES and BMS in PPCI after > 3 years of follow‐up.	8 RCTs and 5 observational studies. 5797 patients in whom 1st‐generation DES (SES or PES) were compared with BMS control arms.	Patients with DES had lower risk of TLR, TVR, and MACE. Incidence of stent thrombosis equal between groups. No difference in mortality or recurrent MI. Those receiving DES had lower mortality.	DES use resulted in decreased repeat revascularization with no increase in stent thrombosis, mortality, or recurrent MI.
Outcomes with various DES or BMS in patients with STEMI [4].	Efficacy (TVR) and safety (death, MI, and stent thrombosis) outcomes at the longest reported follow‐up times with DES compared with BMS.	28 randomized clinical trials; 34,068 patients comparing any DES against each other or BMS.	No increase in the risk of death, MI, or stent thrombosis with any DES compared with BMS. EES was associated with a statistically significant reduction in the rate of stent thrombosis when compared with SES, PES, and even BMS.	DES versus BMS was associated with substantial decrease in the risk of TVR. EES had substantial reduction in the risk of stent thrombosis with no increase in very late stent thrombosis.
Benefits of DES compared with BMS in STEMI: 4‐year results of PES or SES vs. BMS in primary angioplasty (PASEO) randomized trial [5].	To evaluate the short and long‐term benefits of SES and PES vs. BMS in patients undergoing primary angioplasty.	270 patients with STEMI were randomized to BMS (n = 90), PES (n = 90), or SES (n = 90).	PES and SES were associated with significant reduction in TLR at 1year. No difference was observed in terms of death and reinfarction.	SES and PES are safe and associated with significant benefits in terms of TLR up to 4 years of follow‐up, compared with BMS.
PPCI for AMI: long‐term outcome after BMS and DES Implantation [6].	To investigate the long‐term outcomes of unselected patients undergoing PPCI with BMS and DES.	1738 patients undergoing PPCI for a new lesion. 3 cohorts of BMS (n = 531), SES (n = 185) or PES (n = 1022).	No differences in all‐cause mortality or repeat revascularization between DES and BMS. SES was associated with lower rates of all‐cause death, nonfatal MI, or TVR compared with PES. Very late stent thrombosis only occurred in the DES groups.	DES are not associated with an increase in adverse events compared with BMS when used for PPCI, neither DES reduced repeat revascularizations.
Safety and efficacy outcomes of first‐ and second‐generation durable polymer DES and biodegradable polymer BES in clinical practice: comprehensive network meta‐analysis [7].	To investigate the safety and efficacy of durable polymer DES and biodegradable polymer BES.	60 randomized controlled trials were compared, which involved 63,242 patients treated with DES.	At 1year, there were no differences in mortality. Resolute and EZES, EES and SES were associated with reduced odds of MI compared with PES. Compared with EES, BP‐BES were associated with increased odds of MI, wh...

Table of contents

• Cover
• Title Page
• Table of Contents
• List of Contributors
• Preface
• Part I: Guidelines, Thrombolytic Therapy, Pharmacology
• Part II: The STEMI Procedure
• Part III: The STEMI Process
• Part IV: Global STEMI Initiatives
• Part V: Future Perspectives
• Index
• End User License Agreement