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  • 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)www.escardio.org/guidelines

    The Task Force for the management of acute myocardial infarction in patients presenting

    with ST-segment elevation of the European Society of Cardiology

    2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

    Chairpersons: Borja Ibanez (Spain), Stefan James (Sweden).

    Authors/Task Force Members: Stefan Agewall (Norway), Manuel J. Antunes (Portugal), Chiara Bucciarelli-Ducci (UK), Héctor Bueno (Spain), Alida L. P. Caforio (Italy), Filippo Crea

    (Italy), John A. Goudevenos (Greece), Sigrun Halvorsen (Norway), Gerhard Hindricks

    (Germany), Adnan Kastrati (Germany), Mattie J. Lenzen (The Netherlands), Eva Prescott (Denmark), Marco Roffi (Switzerland), Marco Valgimigli (Switzerland), Christoph Varenhorst

    (Sweden), Pascal Vranckx (Belgium), Petr Widimský (Czech Republic).

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    ESC

    WG - Cardiovascular Pharmacotherapy

    WG - Cardiovascular Surgery

    EACVI - European Association of Cardiovascular Imaging

    ACCA - Acute Cardiovascular Care Association

    HFA - Heart Failure Association

    EHRA - European Heart Rhythm Association

    Council - Cardiovascular Nursing and Allied Professions

    EAPCI - European Association of PCI

    WG - Myocardial and Pericardial Diseases

    WG - Thrombosis

    EAPC -- European Association of Preventive cardiology

    Council – for Cardiology practice

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    -1224 comments

    and requests

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    Task Force Members

    2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)www.escardio.org/guidelines

    19 Authors

    ESC

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    Level of evidence

    3

    21%

    159 recommendations

    based on 477 references

    A

    B

    C

    37 23%

    44 28%

    78 49%

    A Data derived from multiple randomized clinical trials or meta-analyses.

    B Data derived from a single randomized clinical trial or large non-randomized studies.

    C Consensus of opinion of the experts and/or small studies, retrospective studies, registries.

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    2017 NEW / REVISED CONCEPTS

    STRATEGY SELECTION AND TIME DELAYS: • Clear definition of first medical contact (FMC). • Definition of “time 0” to choose reperfusion strategy (i.e. the strategy clock starts at the time of

    “STEMI diagnosis”). • Selection of PCI over fibrinolysis: when anticipated delay from “STEMI diagnosis” to wire crossing is ≤120 min. • Maximum delay time from “STEMI diagnosis” to bolus of fibrinolysis agent is set in 10 min. • “Door-to-Balloon” term eliminated from guidelines.

    ELECTROCARDIOGRAM AT PRESENTATION: • Left and right bundle branch block considered equal for recommending urgent angiography if ischaemic

    symptoms.

    TIME LIMITS FOR ROUTINE OPENING OF AN IRA: • 0-12h (Class I); 12-48h (Class IIa); >48h (Class III).

    MINOCA AND QUALITY INDICATORS: • New chapters dedicated to these topics.

    PATIENTS TAKING ANTICOAGULANTS: • Acute and chronic management presented.

    TIME TO ANGIOGRAPHY AFTER FIBRINOLYSIS: • Timeframe is set in 2-24h after successful fibrinolysis.

    What is new in 2017 Guidelines on AMI-STEMI

    4

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    Modes of patient presentation, components of ischaemic time and flowchart for reperfusion strategy selection

    Total ischaemic time

    Total ischaemic time

    Patient delay EMS delay

    Patient delay

    System delay

    System delay

    FMC: EMS

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    Modes of patient presentation, components of ischaemic time and flowchart for reperfusion strategy selection

    Total ischaemic time

    Total ischaemic time

    Patient delay EMS delay

    Patient delay

    System delay

    System delay

    FMC: EMS

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    Modes of patient presentation, components of ischaemic time and flowchart for reperfusion strategy selection

    Total ischaemic time

    Total ischaemic time

    Patient delay EMS delay

    Patient delay

    System delay

    System delay

    FMC: EMS

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    Reperfusion strategies in the infarct-related artery according to time from symptoms onset

    Ea rl

    y p

    h as

    e o

    f ST

    EM I

    3 hours

    Symptoms onset

    0 Primary PCI

    Primary PCI

    Fibrinolysis (only if PCI cannot be performed

    within120 min from STEMI diagnosis)

    Fibrinolysis (only if PCI cannot be performed

    within120 min from STEMI diagnosis)

    I A I A

    I A

    I A

    12

    12 hours

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    Reperfusion strategies in the infarct-related artery according to time from symptoms onset (continued)

    Ev o

    lv e

    d S

    TE M

    I

    48 hours

    R e

    ce n

    t ST

    EM I

    I C

    Primary PCI (if symptoms,

    hemodynamic instabilicy, or arrhythmias)

    Primary PCI (asymptomatic stable patients)

    III A Routine PCI (asymptomatic stable patients)

    IIa B

    12 hours

    13

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    What is new in 2017 Guidelines on AMI-STEMI

    14

    CHANGE IN RECOMMENDATIONS2012 2017

    Same dose i.V in all patients Half dose i.V. in Pts ≥75 years

    STREAM

    Oxygen when SaO2

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    What is new in 2017 Guidelines on AMI-STEMI

    15

    CHANGE IN RECOMMENDATIONS2012 2017

    Same dose i.V in all patients Half dose i.V. in Pts ≥75 years

    STREAM

    Oxygen when SaO2

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    What is new in 2017 Guidelines on AMI-STEMI

    16

    CHANGE IN RECOMMENDATIONS2012 2017

    Same dose i.V in all patients Half dose i.V. in Pts ≥75 years

    STREAM

    Oxygen when SaO2

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    What is new in 2017 Guidelines on AMI-STEMI

    17

    CHANGE IN RECOMMENDATIONS2012 2017

    Same dose i.V in all patients Half dose i.V. in Pts ≥75 years

    STREAM

    Oxygen when SaO2

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    What is new in 2017 Guidelines on AMI-STEMI

    18

    CHANGE IN RECOMMENDATIONS2012 2017

    Same dose i.V in all patients Half dose i.V. in Pts ≥75 years

    STREAM

    Oxygen when SaO2

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    What is new in 2017 Guidelines on AMI-STEMI

    19

    CHANGE IN RECOMMENDATIONS2012 2017

    Same dose i.V in all patients Half dose i.V. in Pts ≥75 years

    STREAM

    Oxygen when SaO2

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    What is new in 2017 Guidelines on AMI-STEMI

    20

    CHANGE IN RECOMMENDATIONS2012 2017

    Same dose i.V in all patients Half dose i.V. in Pts ≥75 years

    STREAM

    Oxygen when SaO2

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STEMI (European Heart Journal 2017 - doi:10.1093/eurheartj/ehx095)

    What is new in 2017 Guidelines on AMI-STEMI

    21

    CHANGE IN RECOMMENDATIONS2012 2017

    Same dose i.V in all patients Half dose i.V. in Pts ≥75 years

    STREAM

    Oxygen when SaO2

  • www.escardio.org/guidelines 2017 ESC Guidelines for the Management of AMI-STE

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