Research grant (to the institution, UCR) - …pic2.cmt.com.cn/WebImages/Res/20120829/20120829_48... · Research grant (to the institution: INSERM U698): NYU School of Medicine, Sanofi,

www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215

Research grant (to the institution, UCR)

AstraZeneca, Daiichi Sankyo, Eli Lilly, BMS, Medtronic, Boston Scientific, Terumo

Inc, Vascular Solutions

Speaking or consulting:

AstraZeneca, Eli Lilly, Merck, Sanofi-Aventis, Boston Scientific

Stockholding: None

Stefan James Potential conflicts of interest


Gabriel Steg Potential conflicts of interest

Research grant (to the institution: INSERM U698):

NYU School of Medicine, Sanofi, Servier

Speaking or consulting:

Ablynx, Amarin, Astellas, AstraZeneca, Bayer, Boehringer- Ingelheim, BMS, Daiichi-

Sankyo-Lilly, GSK, Medtronic, Merck, Novartis, Otsuka, Pfizer, Roche, sanofi,

Servier, The Medicines Company

Stockholding: Aterovax


European Heart Journal

doi:10.1093/eurheartj/ehs215

ESC Guidelines for the management of acute myocardial

infarction in patients presenting with ST-segment

elevation The Task Force on the management of ST-segment elevation acute myocardial

infarction of the European Society of Cardiology

Authors/Task Force Members: Ph. Gabriel Steg (Chairperson) (France)*, Stefan K. James (Chairperson) (Sweden)*, Dan Atar

(Norway), Luigi P. Badano (Italy), Carina Blomstrom Lundqvist (Sweden), Michael A. Borger (Germany), Carlo Di Mario (United

Kingdom), Kenneth Dickstein (Norway), Gregory Ducrocq (France), Francisco Fernandez-Aviles (Spain), Anthony H. Gershlick (United

Kingdom), Pantaleo Giannuzzi (Italy), Sigrun Halvorsen (Norway), Kurt Huber (Austria), Peter Juni (Switzerland), Adnan Kastrati

(Germany), Juhani Knuuti (Finland), Mattie J. Lenzen (Netherlands), Kenneth W. Mahaffey (USA), Marco Valgimigli (Italy), Arnoud van't

Hof (Netherlands), Petr Widimsky (Czech Republic), Doron Zahger (Israel)

ESC Committee for Practice Guidelines (CPG): Jeroen J. Bax (Chairman) (Netherlands), Helmut Baumgartner (Germany), Claudio

Ceconi (Italy), Veronica Dean (France), Christi Deaton (UK), Robert Fagard (Belgium), Christian Funck-Brentano (France), David Hasdai

(Israel), Arno Hoes (Netherlands), Paulus Kirchhof (Germany/UK), Juhani Knuuti (Finland), Philippe Kolh (Belgium), Theresa McDonagh

(UK), Cyril Moulin (France), Bogdan A. Popescu (Romania), Željko Reiner (Croatia), Udo Sechtem (Germany), Per Anton Sirnes

(Norway), Michal Tendera (Poland), Adam Torbicki (Poland), Alec Vahanian (France), Stephan Windecker (Switzerland)

Document Reviewers: David Hasdai (CPG Review Coordinator) (Israel), Felicity Astin (UK), Karin Åström-Olsson (Sweden), Andrzej

Budaj (Poland), Peter Clemmensen (Denmark), Jean-Philippe Collet (France), Keith A. Fox (UK), Ahmet Fuat (UK), Olivija Gustiene

(Lithuania), Christian W. Hamm (Germany), Petr Kala (Czech Replublic), Patrizio Lancellotti (Belgium), Aldo Pietro Maggioni (Italy), Béla

Merkely (Hungary), Franz-Josef Neumann (Germany), Massimo F. Piepoli (Italy), Frans Van de Werf (Belgium), Freek Verheugt

(Netherlands), Lars Wallentin (Sweden)


Classes of recommendations


Definition Suggested wording to use

Class I Evidence and/or general agreement

that a given treatment or procedure is

beneficial, useful, effective.

Is recommmended/

is indicated.

Class II Conflicting evidence and/or a

divergence of opinion about the

usefulness/efficacy of the given

treatment or procedure.

Class IIa Weight of evidence/opinion is in

favour of usefulness/efficacy.

Should be considered.

Class IIb Usefulness/efficacy is less well

established by evidence/opinion.

May be considered.

Class III Evidence or general agreement that

the given treatment or procedure is

not useful/effective, and in some

cases may be harmful.

Is not recommended.



157 recommendations

I IIa

IIb

III

96

61%

37

24%

11

7% 13

8%



157 recommendations

I IIa

IIb

III

96

61%

37

24%

11

7% 13

8%

77

57% 31

23%

19

14%

8

6%

I

III

IIa

IIb

135 recommendations

in ESC 2008 GL


Levels of evidence

Level of

Evidence A

Data derived from multiple randomized

clinical trials or meta-analyses.

Level of

Evidence B

Data derived from a single randomized

clinical trial or large non-randomized studies.

Level of

Evidence C

Consensus of opinion of the experts and/

or small studies, retrospective studies,

registries.


Levels of evidence

21%

157 recommendations

based on 346 references 33 21%

55 35%

69 44%

A

B

C


Levels of evidence

21%

157 recommendations

based on 346 references

30 22%

54 40%

51 38%

A

C

B

33 21%

55 35%

69 44%

A

B

C ESC 2008 GL

135 recommendations

based on 257 references


C

Levels of evidence

Remaining need for

research

69

44%


What is new?

• Early Diagnosis

• Expanded section, atypical presentations

• Cardiac Arrest

• Expanded section. The role of therapeutic hypothermia and angiography

defined.

• Pre Hospital Logistics of Care

• Role of pre hospital diagnosis, triage and networks highlighted

• Reperfusion strategies

• Modified recommended maximal time delays, angio post fibrinolysis

• PCI strategies

• Stent recommendations, anti thrombotic therapy

• Routine therapies and strategies

• Duration of hospital stay, secondary prevention, duration of anti thrombotic

therapy, Evaluation of LV function and viability


Cardiac arrest


Components of delay in STEMI and ideal

time intervals for intervention


Prehospital and in-hospital management, and

reperfusion strategies within 24 h of FMC


Important delays and treatment goals in the

management of acute STEMI


Reperfusion therapy


Procedural aspects of primary PCI


Periprocedural anti thrombotic medication in

primary PCI



primary PCI, con’t



primary PCI, con’t


Routine therapies in the acute, subacute

and long term phase of STEMI


Routine therapies in the acute, subacute

and long term phase of STEMI


Available online

Documents

Research grant (to the institution, UCR) - …pic2.cmt.com.cn/WebImages/Res/20120829/20120829_48... · Research grant (to the institution: INSERM U698): NYU School of Medicine, Sanofi,