A review of PCI and antithrombotic therapies in acute myocardial infarction with cardiogenic shock recommends transradial access and drug-eluting stents, noting a lack of high-quality randomized data.
In this review, we report a contemporary appraisal of the available evidence focusing on adjunctive antithrombotic therapy and technical aspects of percutaneous coronary interventions (PCI) in patients with acute myocardial infarction and cardiogenic shock (AMICS). Only few randomized trials have been conducted to evaluate the optimal arterial access choice, antithrombotic therapy, stent type, or the role of aspiration thrombectomy in this population. Observational data suggest that a transradial approach should be preferred for experienced operators, although knowledge and experience of transfemoral access is required to place any mechanical support device. In the absence of high-quality evidence to guide choice of the adjunctive antithrombotic drugs to support PCI in patients with AMICS, knowledge of the altered pharmacokinetics and pharmacodynamics in shock is required to inform decisions. Drug-eluting stents should be favored over bare-metal stents, and routine thrombectomy is not encouraged. Owing to the challenges inherent to the conduct of randomized trials in this acutely ill patient population, concerted multicenter, and international efforts are paramount to orchestrate the development of high-quality evidence to guide clinical practice.
Marquis‐Gravel et al. (Wed,) conducted a review in Acute myocardial infarction and cardiogenic shock (AMICS). Adjunctive antithrombotic therapy and percutaneous coronary interventions (PCI) was evaluated. A review of PCI and antithrombotic therapies in acute myocardial infarction with cardiogenic shock recommends transradial access and drug-eluting stents, noting a lack of high-quality randomized data.
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