1. the IIa-level recommendation for the use of glycoprotein IIb/IIIa inhibitors remains the same, even if recent trials have shown that the benefit of these drugs has decreased in subjects previously receiving a
combined antiplatelet treatment.
2. considering data obtained through the TRITON-TIMI trial, prasugrel, as antiplatelet therapy before angioplasty (except for patients with STEMI having had ischemic ictus or TIA), is recommended. An alternative is given by an increased clopidogrel dose (600 mg instead of 300). The (not advised) association of clopidogrel and protonic pump inhibitors is
not mentioned.
3. bivalidurin is now considered an acceptable anticoagulation agent in angioplasty, according to the data from HORIZONS-AMI trial (class I, B level of evidence).
4. with a new level-I recommendation, the development of an effective STEMI management is encouraged through hemodynamics and protocols for the transfer to specialized centers, above all for patients at a high
cardiovascular risk.
5. a IIa-level recommendation is introduced to perform the manual aspiration of the blood clot before angioplasty.
6. medicated stents are now considered a valid alternative (IIa level) to non-medicated metal stents in patients with STEMI (patients with unstable angina or non-STEMI remain at IIb level).
7. a new IIb-level recommendation concerns angioplasty for the lesions of the main left coronary artery in patients with a low surgical risk.
The advice to perform a control angiography after 2-6 months from the procedure has been deleted.
8. the early use of a double antiaggregation therapy in patients with unstable angina or non-STEMI is now recommended, with an angiography within 12-24 hours from hospitalization.
