This quick-reference open access handbook offers a concise and practical review of key aspects of the treatment of ST-segment elevation myocardial infarction (STEMI) in the era of primary percutaneous coronary intervention (PPCI). In the context of STEMI, PPCI is the preferred mode of emergency revascularization. Access to PPCI is rapidly increasing and is now routinely practiced in both general and specialist hospitals and there has been a recent emphasis on developing STEMI networks to enhance and expedite the referral pathway. This coupled with concurrent developments to enhance the safety and efficacy of the PPCI procedure has heralded an era where STEMI interventions are increasingly considered an important subspecialty within interventional cardiology.

Written by leading cardiologists who have been instrumental in the adoption of PPCI in their respective institutions, the book provides junior and senior cardiologists alike with insightful and thought-provoking tips and tricks to enhance the success of PPCI procedures, which may in turn translate into direct improvements in outcomes. The book is also relevant for healthcare providers and emergency department physicians.

Contents

• Preface
• Acknowledgments
• About the Editors
• 1. Historical Perspectives on Management of Acute Myocardial Infarction
  Zhen Vin Lee and Bashir Hanif.
  Published online: July 14, 2018.
  • 1.1. Introduction
  • 1.2. Angina Pectoris as a Clinical Entity
  • 1.3. Development of the Electrocardiogram
  • 1.4. Evolving Concepts in Pathophysiology of Myocardial Infarction
  • 1.5. Cardiopulmonary Resuscitation and External Defibrillation
  • 1.6. The Coronary Care Unit
  • 1.7. Concept of Reduction of Infarct Size
  • 1.8. Advent of Thrombolysis and Role of Aspirin
  • 1.9. Coronary Angiography and Percutaneous Revascularization
  • 1.10. Progress of Adjunctive Pharmacotherapy
  • References
• 2. Prehospital Diagnosis and Management of Acute Myocardial Infarction
  Adam J. Brown, Francis J. Ha, Michael Michail, and Nick E. J. West.
  Published online: July 14, 2018.
  • 2.1. Introduction
  • 2.2. Activation of Emergency Services
  • 2.3. Diagnosis of Myocardial Infarction
  • 2.4. Prehospital Treatment of Myocardial Infarction
  • 2.5. Summary
  • References
• 3. Primary Angioplasty: Efficacy and Outcomes
  Ian Patrick Kay and Brittany Georgia Kay.
  Published online: July 14, 2018.
  • 3.1. Introduction
  • 3.2. Treatment of STEMI
  • 3.3. Fibrinolytic Therapy
  • 3.4. Late Presentation PPCI
  • 3.5. Door-To-Balloon Time (D2B)
  • 3.6. Time from First Medical Contact with the Healthcare System (System Delay)
  • 3.7. Direct Transfer from the Community
  • 3.8. The Door-In to Door-Out (DIDO) Time
  • 3.9. Non-system Factors Leading to Delay
  • 3.10. What Is New in the ESC 2017 Guidelines on AMI-STEMI? New/Revised Concepts
  • 3.11. Summary
  • Further Readings
• 4. ST-Elevation Myocardial Infarction Networks and Logistics: Rural and Urban
  Jithendra B. Somaratne, James T. Stewart, Peter N. Ruygrok, and Mark W. Webster.
  Published online: July 14, 2018.
  • 4.1. Introduction
  • 4.2. Organisation of a Regional ST-Elevation Myocardial Infarction Network
  • 4.3. Emergency Medical Service
  • 4.4. Primary Care Service or Non-primary Percutaneous Coronary Intervention Centre
  • 4.5. Emergency Department at a Primary Percutaneous Coronary Intervention Centre
  • 4.6. Cardiac Catheterisation Laboratory
  • 4.7. Implementation of a Regional ST-elevation Myocardial Infarction Network
  • 4.8. Quality Control
  • 4.9. Case Study
  • 4.10. Summary
  • Further Readings
• 5. Utilization of PCI After Fibrinolysis
  Peter McKavanagh, George Zawadowski, and Warren J. Cantor.
  Published online: July 14, 2018.
  • 5.1. Introduction
  • 5.2. Fibrinolytic Therapy
  • 5.3. PCI-Based Approaches
  • 5.4. Antiplatelet Therapy as Adjunct to Fibrinolysis
  • 5.5. Optimal Timing of PCI After Fibrinolytic Therapy
  • References
• 6. Catheter Laboratory Design, Staffing and Training
  Cara Hendry and Rizwan Rashid.
  Published online: July 14, 2018.
  • 6.1. Introduction
  • 6.2. Personnel: The “Cath Laboratory Team”
  • 6.3. Protective Equipment
  • 6.4. Equipment
  • References
• 7. Patient Preparation, Vascular Access, and Guiding Catheter Selection
  Fuminobu Yoshimachi and Yuji Ikari.
  Published online: July 14, 2018.
  • 7.1. Patient Preparation
  • 7.2. Vascular Access
  • 7.3. Guiding Catheter Selection
  • 7.4. Left Coronary Artery
  • 7.5. Benefits of Universal Guiding Catheters
  • 7.6. Case Report: Primary PCI Using an Ikari Guide
    Fuminobu Yoshimachi and Yuji Ikari.
  • References
• 8. Dual Antiplatelet and Glycoprotein Inhibitors in Emergency PCI
  Alan Yean Yip Fong and Hwei Sung Ling.
  Published online: July 14, 2018.
  • 8.1. Introduction
  • 8.2. Aspirin
  • 8.3. P₂Y₁₂ Inhibitors
  • 8.4. Glycoprotein IIb/IIIa Inhibitors
  • 8.5. Recommended Treatment Algorithms from Consensus Guidelines
  • 8.6. Summary
  • References
• 9. Anticoagulants and Primary PCI
  Fahim H. Jafary.
  Published online: July 14, 2018.
  • 9.1. Introduction
  • 9.2. Rationale for the Use of Anticoagulant Therapy
  • 9.3. Classes of Anticoagulant
  • 9.4. Monitoring of Intensity of Anticoagulation in the Cardiac Catheterization Laboratory
  • 9.5. Approach to the Patient Who Has Received Anticoagulation Prior to Primary PCI
  • 9.6. Role of Anticoagulation Following Successful PCI
  • 9.7. Summary
  • References
• 10. Management of Intracoronary Thrombus
  Janarthanan Sathananthan, Timothy J. Watson, Dale Murdoch, Christopher Overgaard, Deborah Lee, Deanna Khoo, and Paul J. L. Ong.
  Published online: July 14, 2018.
  • 10.1. Introduction
  • 10.2. Pathophysiology of Intracoronary Thrombus Formation
  • 10.3. Management
  • 10.4. Thrombectomy
  • 10.5. Other Causes of Intracoronary Thrombus Formation in STEMI Patients
  • 10.6. Stenting Strategy
  • 10.7. Conclusion
  • 10.8. Case Report: Heavy Thrombus Load in Primary PCI
    Janarthanan Sathananthan, Dale Murdoch, and Christopher Overgaard.
  • 10.9. Acute STEMI with Extensive Thrombus: An Illustrative Case
    Deborah Lee, Deanna Khoo, and Paul JL Ong.
  • References
• 11. Is There a Role for Bare-Metal Stents in Current STEMI Care?
  Mark Hensey, Janarthanan Sathananthan, Wahyu Purnomo Teguh, and Niall Mulvihill.
  Published online: July 14, 2018.
  • 11.1. Introduction
  • 11.2. Bare-Metal Stents
  • 11.3. Drug-Eluting Stents
  • 11.4. DES vs. BMS for Primary PCI
  • 11.5. Summary and Recommendations
  • 11.6. Case Report: Primary PCI with Direct Stenting in Patient with Inferior Myocardial Infarction
    Wahyu Purnomo Teguh.
  • Further Readings
• 12. Drug-Coated Balloons in STEMI
  Upul Wickramarachchi, Hee Hwa Ho, and Simon Eccleshall.
  Published online: July 14, 2018.
  • 12.1. Introduction
  • 12.2. Drug-coated Balloons
  • 12.3. Evidence for DCB Angioplasty in PPCI
  • 12.4. Technical Tips and Tricks with DCB-Only Angioplasty in Primary PCI
  • 12.5. Conclusion
  • 12.6. Primary PCI of RCA with Drug-Coated Balloon Angioplasty
    Upul Wickramarachchi, , Hee Hwa Ho, and Simon Eccleshall.
  • References
• 13. Culprit-Only Artery Versus Multivessel Disease
  Valeria Paradies and Pieter C. Smits.
  Published online: July 14, 2018.
  • 13.1. Introduction
  • 13.2. State of the Art: Current Recommendations
  • 13.3. Role of Fractional Flow Reserve
  • 13.4. Prognostic Value of Complete Revascularization
  • 13.5. STEMI with Multivessel Coronary Artery Disease Complicated by Cardiogenic Shock
  • 13.6. Clinical Practice
  • 13.7. Case Report
    Valeria Paradies and Peter C. Smits.
  • Further Readings
• 14. Role of Intravascular Imaging in Primary PCI
  William K. T. Hau and Bryan P. Y. Yan.
  Published online: July 14, 2018.
  • 14.1. Introduction
  • 14.2. Role of Invasive Imaging in the Management of STEMI and Non-STEMI
  • 14.3. Role of Invasive Imaging in the Management of Spontaneous Coronary Artery Dissection
  • 14.4. Summary
  • References
• 15. Physiological Lesion Assessment in STEMI and Other Acute Coronary Syndromes
  Katherine M. Yu and Morton J. Kern.
  Published online: July 14, 2018.
  • 15.1. Introduction
  • 15.2. ACS and FFR Case
  • 15.3. Fractional Flow Reserve Foundations
  • 15.4. Fundamentals of Fractional Flow Reserve in STEMI and Other ACS
  • 15.5. Fractional Flow Reserve and STEMI Revascularization Guidance
  • 15.6. FFR in Other Acute Coronary Syndrome
  • 15.7. Coronary Flow Reserve and the Index of Microvascular Resistance
  • 15.8. Instant Wave-Free Ratio
  • Disclosures
  • References
• 16. Role of Coronary Artery Bypass Surgery in Acute Myocardial Infarction
  William Y. Shi and Julian A. Smith.
  Published online: July 14, 2018.
  • 16.1. Introduction
  • 16.2. Indications for CABG in Acute MI
  • 16.3. Timing of CABG After Acute Myocardial Infarction
  • 16.4. CABG in Cardiogenic Shock
  • 16.5. Peri-operative and Operative Considerations
  • 16.6. Intra-aortic Balloon Pump (IABP)
  • 16.7. Intra-operative Considerations
  • 16.8. Results of CABG in Acute MI
  • 16.9. Conclusions
  • 16.10. Coronary Artery Bypass Surgery for STEMI
    William Y. Shi and Julian A. Smith.
  • 16.11. Illustrative Cases
  • Further Readings
• 17. A Handbook of Primary PCI: No-Reflow Management
  Julien Adjedj, Olivier Muller, and Eric Eeckhout.
  Published online: July 14, 2018.
  • 17.1. Introduction
  • 17.2. Definition
  • 17.3. Pathophysiology
  • 17.4. Aetiology
  • 17.5. Diagnosis
  • 17.6. Management of No-Reflow
  • 17.7. Outcome
  • References
• 18. Medications in Cardiogenic Shock
  Mei-Tzu Wang, Cheng Chung Hung, and Wei-Chun Huang.
  Published online: July 14, 2018.
  • 18.1. Introduction
  • 18.2. Definition and Initial Assessment
  • 18.3. Initial Approach to the Patient in Cardiogenic Shock (VIP)
  • 18.4. Vasoactive and Inotropic Agents
  • 18.5. Vasoactive Agents
  • 18.6. Inotropic Agents
  • 18.7. Outcome
  • 18.8. Conclusion
  • 18.9. Case Example: Successful Medical Management of Cardiogenic Shock
    Cheng Chung Hung and Wei-Chun Huang.
  • References
• 19. Mechanical Circulatory Support in ST-Elevation Myocardial Infarction
  Nathan Lo and E. Magnus Ohman.
  Published online: July 14, 2018.
  • 19.1. Introduction
  • 19.2. Definition and Identification of Cardiogenic Shock
  • 19.3. Pathophysiology of Cardiogenic Shock Complicating Myocardial Infarction
  • 19.4. Intra-aortic Balloon Pump
  • 19.5. Axial-Flow Pump (Impella)
  • 19.6. Extracorporeal Left Heart Bypass (TandemHeart)
  • 19.7. Extracorporeal Membrane Oxygenation
  • 19.8. Practical Approach to the Use of Mechanical Support Devices in STEMI
  • 19.9. Summary
  • 19.10. Case Report: Severe Cardiogenic Shock in Context of Cardiac Arrest
    Nathan Lo and E. Magnus Ohman.
  • Further Readings
• 20. Mechanical Complications of Acute Myocardial Infraction
  Wei Wang and Anson Cheung.
  Published online: July 14, 2018.
  • 20.1. Introduction
  • 20.2. Ischemic Ventricular Septal Defect
  • 20.3. Acute Mitral Valve Regurgitation Secondary to Papillary Muscle Rupture
  • 20.4. Left Ventricular Free Wall Rupture
  • 20.5. Case Reports: Mechanical Complications of Acute Myocardial Infraction
    Wei Wang and Anson Cheung.
  • References
• 21. Time to Reperfusion, Door-to-Balloon Times, and How to Reduce Them
  Margot M. Sherman Jollis and James G. Jollis.
  Published online: July 14, 2018.
  • 21.1. Introduction
  • 21.2. Does Time Matter?
  • 21.3. How to Reduce Time
  • 21.4. Expediting Care According to Point of Entry
  • 21.5. Walk-In
  • 21.6. Arrival by Ambulance
  • 21.7. Inter-Hospital Transfer
  • 21.8. STEMI in Patients Already Hospitalized for Another Condition
  • 21.9. Case Reports: Time to Reperfusion, Door-to-Balloon Times, and How to Reduce Them
    Margot M. Sherman Jollis and James G. Jollis.
  • References
• 22. Strategies for Reducing Myocardial Infarct Size Following STEMI
  Valeria Paradies, Mervyn Huan Hao Chan, and Derek J. Hausenloy.
  Published online: July 14, 2018.
  • 22.1. Introduction
  • 22.2. Myocardial Reperfusion Injury: A Residual Target for Cardioprotection in STEMI
  • 22.3. Strategies for Targeting Reperfusion Injury to Reduce MI Size Following STEMI
  • 22.4. Anti-platelet and Anti-thrombotic Strategies to Reduce MI Size Following STEMI
  • 22.5. Targeted Mitochondria to Reduce MI Size Following STEMI
  • 22.6. Metoprolol: Beta-Blocker Therapy to Reduce MI Size Following STEMI
  • 22.7. Nitric Oxide Donors to Reduce MI Size Following STEMI
  • 22.8. Optimising the Translation of Cardioprotection into the Clinical Setting
  • 22.9. Future Perspectives
  • 22.10. Case Report: Strategies for Reducing Myocardial Infarct Size Following STEMI
    Valeria Paradies, Mervyn Huan Hao Chan, and Derek J. Hausenloy.
  • Conflicts of Interest
  • Further Readings
• 23. Primary PCI: Outcomes and Quality Assessment
  John S. Douglas.
  Published online: July 14, 2018.
  • 23.1. Introduction
  • 23.2. Quality Assessment
  • 23.3. Risk Assessment and Adjustment
  • 23.4. Procedural Outcomes
  • 23.5. Audit
  • 23.6. Conclusion
  • 23.7. Case Presentation
  • References

To our friends, colleagues, mentors who have worked tirelessly to develop and refine acute cardiac care. This work is dedicated to supporting ongoing growth and development of primary PCI as the most effective treatment for myocardial infarction.

T. J. Watson, P. J. L. Ong

To my wife and forever sweetheart Marianne, for her eternal patience and enduring love.

J. E Tcheng