Abstract

New Guidelines and Highlights for Coronary Artery Disease

Agus Harsoyo,MD

Unit Clinical Cardiac Electrophysiology and Device Implantation

Department of Cardiology, Faculty of Medicine Universitas Indonesia
RSPAD Gatot Soebroto Jakarta

In 2017, European Society of Cardiology (ESC) simultaneously published two

updates on the management of patients with ST-segment elevation myocardial
infarction (STEMI) and dual antiplatelet therapy (DAPT) in Coronary Artery Disease
(CAD) it was based on the latest clinical trials to expert opinion.
the Guidelines management STEMI has a few changes such as radial access was
preferred over femoral, the use of DES over BMS, complete revascularization,
thrombus aspiration, the use of GPII/III inhibitor, anticoagulant, the used lipid lowering
therapy, complete revascularization on Primary Percutaneous Coronary Intervention
(PPCI) with shock, used P2Y12 inhibitors, pending of stenting, and the concepts of
Myocardial Infarction in Non Obstructive Coronary Artery (MINOCA), strategy of
time delays, time limits for routine opening of an Infarct related Artery (IRA), complete
Right Bundle Branch Block (cRBBB) equal to complete Left Bundle Branch Block
(cLBBB) on urgent angiography, time to angiography after fibrinolysis, taking
anticoagulant.
An update on DAPT in CAD and the duration in different type of situations.
Changes in recommendation from the previous guidelines are pretreatment of P2Y12
if PCI is planned, the use of Proton Pump Inhibitor (PPI), the use of metallic stent and
DAPT duration, switch between P2Y12 inhibitors, risk score for DAPT duration,
DAPT duration in patients without stenting, the use of anticoagulant and DAPT.

Keywords: Coronary artery disease, recommendation STEMI, dual antiplatelet