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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215

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Novel aspects of the STEMI guidelines 2012

Importance of recognizing atypical ECG presentations Immediate angiography with a view to PCI in survivors of cardiac arrest and

STEMI or high suspicion of AMI

Primary PCI is the preferred reperfusion therapy A maximum of 120 min for provision of PCI is accepted in EMS or non-PCI

hospitals, but a delay of < 90 min is the target

Delays must be recorded and monitored FMC to ECG: 10 min FMC to lysis: 30 min FMC to PPCI: 90 min (60 min in PCI hospitals or for early presenters)

Networks should have written protocols, shared between EMS, ED, CCUs DES preferred over BMS for P-PCI Prasugrel or Ticagrelor preferred over clopidogrel as adjunct to ASA in P-PCI Bivalirudin is preferred as anticoagulant for P-PCI, or enoxaparin, over UFH

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Novel aspects of the STEMI guidelines 2012

Routine use of GPIIb/IIIa blockers is downgraded in P-PCI After fibrinolysis

Transfer to a PCI-capable center is indicated in all patients Angio with a view to revascularization indicated after successful lysis (optimal timing 3-24 h)

Special subsets are emphasized (gender, diabetes, renal failure) Guidelines for managing hyperglycemia in the acute phase Minimal CCU (24 h) and hospital LOS (72 h), with early transfer possible After the acute phase:

All pts should have an echocardiogram Stress testing or imaging for viability and ischemia is indicated in pts with MVD

Rehabilitation is indicated in all patients Smoking cessation protocols should be in place in all centers DAPT recommendations (12 mnths, with minimum of 1 for BMS, 6 for DES) -blockers downgraded after STEMI without CHF or LV dysfunction High dose statins in all patients without contraindication or history of intolerance LDL target of 1.8 mmol/L (0.7 g/dL)

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3. Emergency care

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Relief of pain, breathlessness and anxiety

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Cardiac arrest

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Components of delay in STEMI and idealtime intervals for intervention

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Prehospital and in-hospital management, andreperfusion strategies within 24 h of FMC

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Logistics of pre-hospital care

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Logistics of pre-hospital care, cont

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Reperfusion therapy

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Important delays and treatment goals in themanagement of acute STEMI

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Procedural aspects of primary PCI

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Periprocedural anti thrombotic medication inprimary PCI

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Periprocedural anti thrombotic medication inprimary PCI, cont

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Periprocedural anti thrombotic medication inprimary PCI, cont

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Initial dosing of anti thrombotic agents in patients withchronic kidney disease, estimated CrCl

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4. Management during hospitalization

and at discharge

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Logistical issues during hospital stay

C

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PAMI II Criteria (J Am Coll Cardiol. 1998 Apr;31(5):967-72)Age 45%,

one- or two-vessel disease,

successful PTCA,

no persistent arrhythmias

Low Risk patients selection Criteria

for early (day 3) discharge

Zwolle Criteria (Circulation 2004; 109:27372743)Total score 3

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Routine therapies in the acute, subacute and long term phase of STEMI

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Routine therapies in the acute, subacute and long term phase of STEMI

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Documents

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