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Routine thrombectomy and multivessel percutaneous coronary intervention (PCI) were targeted for a shake-up in cath lab guidelines for ST-elevation myocardial infarction (STEMI) patients, summarized in a review of the updated recommendations.

The focused update, originally released in October 2015 by the American College of Cardiology and the American Heart Association in collaboration with the Society for Cardiac Angiography and Interventions, included two changes of note:

• PCI of non-infarct arteries "may be considered" now for selected patients with multivessel disease (Class IIb), a turn from previous warnings that PCI "should not be performed" in these vessels (Class III)
• Routine thrombectomy before primary PCI was downgraded to "is not useful" (Class III) from "reasonable" (Class IIa)

According to , of Houston's Baylor College of Medicine, and , of Munroe Regional Medical Center in Ocala, Fla., the updates reflected findings from recent trials -- PRAMI, CvLPRIT, DANAMI 3-PRIMULTI, and PRAGUE-13 for multivessel PCI, and INFUSE-AMI, TASTE, and TOTAL for thrombectomy -- that negated an older, more limited evidence base.

"For both the strategies of multivessel PCI and routine aspiration thrombectomy in patients with STEMI undergoing primary PCI, the results of these large multicenter randomized clinical trials differed significantly from those of prior studies and analyses, which were generally observational or single-center studies," the pair wrote.

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