What does this research mean for the field?

Primary PCI for acute coronary syndrome patients in Japan achieves a procedural success rate of 97.4% and an in-hospital mortality of 4.4%, with an average STEMI door-to-balloon time of 84 minutes. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The aim is to provide updated guidance on the management of acute coronary syndromes through primary PCI.

February 28, 2026Cardiovascular Intervention and Therapeutics0 citationsOpen Access

CVIT expert consensus document on primary percutaneous coronary intervention (PCI) for acute coronary syndromes (ACS) in 2026

Q: What is the clinical evidence from this study?

Study design: Expert Consensus Document. Population: Patients with acute coronary syndromes (ACS) including STEMI, NSTEMI, and unstable angina undergoing PCI in Japan (n=95667). Intervention: Primary percutaneous coronary intervention (PCI) for ACS vs. Conservative strategy or delayed intervention where applicable. Primary outcome: Procedural success defined as residual stenosis <25% and TIMI 3 flow; and in-hospital mortality.

YOYukio Ozaki ATAkihiro Tobe YOYoshinobu Onuma

Key Result

Primary PCI for ACS patients in Japan achieved a procedural success rate of 97.4% and an in-hospital mortality of 4.4% with STEMI door-to-balloon time averaging 84 ± 53 minutes.

Key Points

The aim is to provide updated guidance on the management of acute coronary syndromes through primary PCI.
Reviewed past consensus documents and recent clinical guidelines.
Incorporated new clinical evidence and technological advancements.
Focused on procedural aspects of primary PCI.
Emphasized the standardization of treatment for ST segment elevation myocardial infarction.
Highlighted improvements in patient outcomes during cardiogenic shock.
Supported by the most recent ESC guidelines and updated research findings.

Study Design

Type

Expert Consensus Document (n=95,667)

Multicenter

Yes

Structured PICO

Population

Patients with acute coronary syndromes (ACS), including ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndromes (NSTE-ACS), undergoing primary percutaneous coronary intervention (PCI) in Japan.

Intervention

Primary percutaneous coronary intervention (PCI) and associated procedural management, including access route, antiplatelet therapy, anticoagulation, and mechanical circulatory support.

This document provides updated 2026 expert consensus recommendations for primary PCI in ACS, specifically tailored to the Japanese clinical context, available pharmacology, and healthcare system.

Limitations

Data primarily from registry and observational sources rather than randomized controlled trials within this document
Limited randomized trial data specific to Japanese population for many procedural aspects
Dose differences in P2Y12 inhibitors between Japan and Europe may affect comparability
Unavailability of GP IIb/IIIa inhibitors in Japan alters treatment context
Some referenced clinical trials were conducted outside Japan and may not directly apply

Abstract

Abstract Primary Percutaneous Coronary Intervention (PCI) has significantly contributed to reducing the mortality of patients with ST segment elevation myocardial infarction (STEMI) even in cardiogenic shock and is now the standard of care in most of Japanese institutions. The Task Force on Primary PCI of the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) proposed an expert consensus document for the management of acute myocardial infarction (AMI) focusing on procedural aspects of primary PCI in 2018 and updated in 2022 (Ozaki et al. in Cardiovasc Interv Ther 33:178–203, 2018), (Ozaki et al. in Cardiovasc Interv Ther 37:1–34, 2022). Following the publication of the 2023 European Society of Cardiology (ESC) Guidelines for the management of acute coronary syndromes, the CVIT Task Force released another revised version in 2024 (Ozaki et al. in Cardiovasc Interv Ther 39:335–375, 2024). In light of new clinical evidence and technological advances that have emerged since then, the Task Force now proposes an updated expert consensus document for the management of ACS focusing on procedural aspects of primary PCI in 2026 version.

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Cite This Study

Ozaki et al. (Thu,) conducted a expert consensus document in Patients with acute coronary syndromes (ACS) including STEMI, NSTEMI, and unstable angina undergoing PCI in Japan (n=95,667). Primary percutaneous coronary intervention (PCI) for ACS vs. Conservative strategy or delayed intervention where applicable was evaluated on Procedural success defined as residual stenosis <25% and TIMI 3 flow; and in-hospital mortality. Primary PCI for ACS patients in Japan achieved a procedural success rate of 97.4% and an in-hospital mortality of 4.4% with STEMI door-to-balloon time averaging 84 ± 53 minutes.

synapsesocial.com/papers/69a286490a974eb0d3c01238 https://doi.org/https://doi.org/10.1007/s12928-025-01229-z