State-of-the-Art Review: Percutaneous Coronary Intervention in Acute Coronary Syndrome

This summarizes the major trials from the past year examining percutaneous coronary intervention (PCI) strategies and adjunct therapies in myocardial infarction.

Significant progress has been made in four areas: (1) mechanical circulatory support in acute myocardial infarction with cardiogenic shock – trials demonstrate that a percutaneous left ventricular assist device provides a significant mortality benefit in select patients. (2) Timing and choice of complete revascularization in patients with MI without shock – trials support earlier complete revascularization during the index procedure or hospitalization. (3) Intravascular imaging – trials highlight that using optical coherence tomography or intravascular ultrasound yields superior outcomes compared to angiographic guidance alone. (4) Dual Antiplatelet Therapy (DAPT) timing – findings indicate that stopping DAPT earlier (within 1–3 months post-PCI) and transitioning to P2Y12 inhibitors is generally safe and effective.

Recent trials underscore the evolving role of advanced technologies and optimized timing in improving outcomes for MI patients, with a focus on individualized and evidence-based care strategies.