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

Abstract

Purpose of the Review: This summarizes the major trials from the past year examining percutaneous coronary intervention (PCI) strategies and adjunct therapies in myocardial infarction. Recent Findings: 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. Summary: 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.