What Could be Changed in the 2012 Taiwan ST-Segment Elevation Myocardial Infarction Guideline?

The 2012 guidelines of the Taiwan Society of Cardiology for the management of ST-segment elevation myocardial infarction (STEMI) is an important reference commonly used by a variety of medical professionals in Taiwan. However, there are several points that may need to be changed or added to the 2012 edition due to the scientific development. First, timely primary percutaneous coronary intervention (PCI) has become the major reperfusion therapy in Taiwan. Immediate transfer to qualified PCI-capable hospitals by ambulance for all STEMI patients is the preferred strategy. Second, dual antiplatelet therapy with aspirin and P2Y12 inhibitor is important for STEMI patients. The newer P2Y12 inhibitors, ticagrelor or prasugrel, have a more potent platelet inhibitory effect and can be used for STEMI patients prepared for primary PCI if there is no contraindication. Third, aspiration thrombectomy and newer generation drug-eluting stents can be considered during primary PCI. For patients with multivessel disease, typically only an infarct-related artery should be treated at the time of primary PCI. All these evidencebased suggestions together provide an ideal initial treatment strategy for acute STEMI in Taiwan.