Kommentar zu den Leitlinien 2017 der Europäischen Gesellschaft für Kardiologie (ESC) zur Therapie des akuten Herzinfarktes bei Patienten mit ST-Streckenhebung

This article comments on the European Society of Cardiology (ESC) clinical practice guidelines on acute myocardial infarction in patients presenting with ST-segment elevation (STEMI), especially regarding the substantial modifications in comparison to the previous guidelines published in 2012. In the field of diagnostics and emergency management, electrocardiography (ECG) diagnostics was re-evaluated in favor of ECG leads from the rear chest wall (V7–V9), as well as left and right bundle branch blocks as indications for coronary angiography. Additional preprocedural oxygen is recommended only in cases of proven low oxygen saturation <90%. New time intervals have been introduced to assess the quality of STEMI care in networks, in particular the interval from the first medical contact to the successful wire passage of a coronary target lesion. In the field of revascularization there is a clear recommendation for the radial access route, the main focus here was on the prevention of bleeding. Thrombus aspiration was devaluated and there was an up-grading of Drug Eluting Stents (DES) with the recommendation that Bare Metal Stents (BMS) should no longer be used. In addition, adjunctive drug therapy, in particular dual antiplatelet therapy (DAPT), as well as the reduction of lipid levels were individualized depending on the respective risk profile. Furthermore, the term myocardial infarction with nonobstructive coronary arteries (MINOCA) was introduced.