Treatment
Aspiration Thrombectomy
ÎÎManual aspiration thrombectomy is reasonable for patients
undergoing primary PCI. (IIa-B)
Use of Stents in Primary PCI
ÎÎPlacement of a stent (bare-metal stent [BMS] or drug-eluting stent
[DES]) is useful in primary PCI for patients with STEMI. (I-A)
ÎÎBMSa should be used in patients with high bleeding risk, inability to
comply with 1 year of dual antiplatelet therapy (DAPT), or anticipated
invasive or surgical procedures in the next year. (I-C)
ÎÎDES should NOT be used in primary PCI for patients with STEMI who
are unable to tolerate or comply with a prolonged course of DAPT
because of the increased risk of stent thrombosis with premature
discontinuation of one or both agents. (III-B: Harm)
a
Balloon angioplasty without stent placement may be used in selected patients.
Adjunctive Antithrombotic Therapy for Primary PCI (Table 3)
Antiplatelet Therapy
ÎÎAspirin 162-325 mg should be given before primary PCI. (I-B)
ÎÎAfter PCI, aspirin should be continued indefinitely. (I-A)
ÎÎA loading dose of a P2Y12 receptor inhibitor should be given as early
as possible or at the time of primary PCI to patients with STEMI.
Options include:
• Clopidogrel 600 mg (I-B) or
• Prasugrel 60 mg (I-B) or
• Ticagrelor 180 mg (I-B)
ÎÎP2Y12 inhibitor therapy should be given for 1 year to patients with
STEMI who receive a stent (BMS or DES) during primary PCI using the
following maintenance doses:
a
• Clopidogrel 75 mg daily (I-B) or
• Prasugrel 10 mg daily (I-B) or
• Ticagrelor 90 mg bida (I-B)
The recommended maintenance dose of aspirin to be used with ticagrelor is 81 mg daily.
ÎÎIt is reasonable to use 81 mg of aspirin per day in preference to higher
maintenance doses after primary PCI. (IIa-B)
ÎÎIt is reasonable to begin treatment with an intravenous GP IIb/
IIIa receptor antagonist such as abciximab (IIa-A), high-bolus-dose
tirofiban (IIa-B), or double-bolus eptifibatide (IIa-B) at the time of
primary PCI (with or without stenting or clopidogrel pretreatment) in
selected patients with STEMI who are receiving unfractionated heparin
(UFH).
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