Latest STEMI treatment: a focus on current and upcoming devices.

INTRODUCTION

Ischemic heart disease is the most common cause of mortality worldwide. In ST elevation myocardial infarction (STEMI) patients, optimization of primary percutaneous coronary intervention (pPCI) is crucial to improve myocardial savage and prevent reperfusion injury. In STEMI patients complicated with cardiogenic shock (CS), percutaneous mechanical circulatory support devices (MCS) have emerged as a therapeutic option in the management of this challenging condition and their use is rapidly increasing.

AREAS COVERED: In this review we discuss how pPCI can be optimized with respect to thrombectomy use, stent selection and revascularization strategy, in order to reduce myocardial damage and to improve clinical outcomes. Moreover, we review the recently-published data for and against the use of commercially available MCS in STEMI patients complicated by CS (intra-aortic balloon pump counterpulsation (IABP), Impella system, TandemHeart, and venous-arterial extracorporeal membrane oxygenation (VA-ECMO)).

EXPERT COMMENTARY: In pPCI, second-generation drug-eluting stent implantation and complete revascularization are always recommended. Thrombectomy does not have any role in improving mortality. In patients with CS, current MCS have shown no improvement in mortality.