COMMENTS ON 2017 EUROPEAN GUIDELINES FOR THEMANAGEMENT OF ACUTE MYOCARDIAL INFARCTION INPATIENTS PRESENTING WITH ST-SEGMENT ELEVATION

Abstract

Updated European guidelines for the management of acute myocardial infarction in patients
presenting with ST-segment elevation were published in 2017. All the new and changed
recommendations was analysed in order to investigate the possibility of their application in our country.
Objective: to reveal essential evidence-based updated points of the 2017 guidelines that can be
implemented in the settings of Kazakhstan health care system.
Materials and methods: the first stage of the review was performing a comparative analysis of old
(2012) and updated versions of the European guidelines. Then, to investigate the possibility of their
application in our country, the search of Asian and Kazakhstan trials was carried out in PubMed,
Cochrane Library, Trip, ScienceDirect. To build search queries, the following key words was used: acute
coronary syndrome, myocardial infarction, guidelines, coronary angiography, stenting.
Results and conclusions: Aforementioned document is remarkable for inclusion of new essential
recommendations, which can be listed in the next statements:
1. the combination of right bundle branch block with clinical symptoms of myocardial ischaemia is
an indication for urgent coronary angiography;
2. time quality indicators of care for patients with acute myocardial infarction have been
reassesed, which will be crucial for Kazakhstan;
3. the recommendations on preferred use of radial access has been strengthened from IIa to IА,
which is supported by numerous investigations in Asia;
4. routine thrombus aspiration is not recommended, and this strategy is proved in Asia;
5. the recommendation on preferred stenting with new-generation drug-eluting stents compared
with bare-metal stents is underscored, and this recommendation is reasonable in Asia, although with a
weaker level of evidence;
6. routine use of deferred stenting is not recommended, and this strategy is proved in Asia;
7. routine percutaneous coronary intervention of a infarct-related artery is not recommended in
stable asymptomatic patients after 48 hour from symptoms onset;
8. routine revascularization of non-infarct-related lesions should be considered in patients with
multivessel disease before hospital discharge, and this recommendation is reasonable in Asia, although
with a weaker level of evidence;
9. oxygen is indicated in patients with hypoxaemia SaO2 < 90% (IC) and routine oxygen is not
recommended (III);

10. the importance of aggressive lipid-lowering therapy depending on the level of low-density
lipoprotein has been underlined, and this strategy proved its effectiveness in real-world clinical settings
in Asian countries;
11. the safety of early discharge has been emphasized, but the possibility of implemention of this
strategy in Kazakhstan should be elucidated in further studies.
Overall, there is a strong necessity for performing high-quality trials in Kazakhstan in order to
compose own valid clinical guidelines.