SCAI Expert Consensus Statement Addresses Managing Patients with STEMI

October 7, 2024—The Society for Cardiovascular Angiography & Interventions (SCAI) announced the publication of an expert consensus statement on the management of patients with ST-elevated myocardial infarction (STEMI) who are referred for primary percutaneous coronary intervention (PCI).

According to SCAI, the expert consensus statement highlights the strengths and limitations of various diagnostic and therapeutic interventions for treating patients with STEMI, provides an overview of managing large thrombus burden and no reflow, and outlines best practices in managing STEMI across anatomic and clinical circumstances.

The document was published by Jacqueline E. Tamis-Holland, MD, et al in JSCAI. Dr. Tamis-Holland, who is Chair of the guideline project. The Cochair of the project is Yader Sandoval, MD.

An accompanying editorial, “Optimizing Primary PCI Care for STEMI Patients: Key Messages From the SCAI Expert Consensus Statement” by Marc-André d’Entremont, MD, et al, was also published in JSCAI.

As summarized in the SCAI press release, the consensus statement provides detailed suggestions for clinicians, particularly for nuanced situations not covered by general guidelines. It was developed using a consensus process that drew from diverse viewpoints within the interventional cardiology community.

The statement synthesizes the latest evidence-based practices and provides comprehensive suggestions to enhance patient care and outcomes. Key aspects of STEMI management, including early diagnosis, reperfusion strategies, and post-procedural care, are addressed.

SCAI stated that the consensus statement discusses the technical aspects of patient care and offers practical approaches for managing thrombus and no-reflow conditions. These include using thrombectomy devices in cases with a large thrombus burden and administering vasodilators to dilate arteries. It provides clear, technical suggestions for treatment.

“This document represents a collective effort to refine and advance the standards of care in STEMI management,” commented Dr. Tamis-Holland in the SCAI press release. “By following these consensus statements, we can enhance the quality of care and make a meaningful difference in the lives of STEMI patients.”

She continued, “This expert consensus statement will help interventional cardiologists make informed decisions and provide the best possible care in the cardiac catheterization laboratory. We are confident that the STEMI consensus statement will serve as a valuable resource for clinicians around the world.”

Dr. Tamis-Holland concluded, “Successful STEMI management should focus on the proper diagnosis and rapid treatment, and also include robust secondary prevention measures and addressing potential complications. Using this approach, we can significantly improve the quality of life and long-term survival of our patients.”

Emphasizing the importance of this consensus document in standardizing STEMI treatment protocols, Dr. Sandoval commented in the press release, “Our goal was to create a document that reflects the most current scientific evidence and offers practical advice for clinicians on the front lines of patient care, as well as offers input on frequently encountered clinical scenarios in STEMI patients such as microvascular obstruction, MINOCA [myocardial infarction with nonobstructive coronary arteries], coronary microvascular dysfunction, including lesion subsets such as bifurcations or calcified lesions, and highlights areas with unmet needs where opportunities exist for additional research.”

Dr. Sandoval added, “By providing these consensus key points, we are not only helping to ensure consistency in treatment approaches but also aiming to improve the overall quality of care for STEMI patients globally. The document will be a critical resource for improving STEMI outcomes worldwide.”

Dr. Tamis-Holland is Institute Director for Acute Coronary Care at Cleveland Clinic in Cleveland, Ohio. Dr. Sandoval is Co-Chairman for the Minneapolis Heart Institute Foundation Center for Coronary Artery Disease in Minneapolis, Minnesota.