ST Elevation Myocardial Infarction

Abstract

Acute ST elevation myocardial infarction (STEMI) is the leading cause of death in the United States. The American Heart Association estimated that there were 920,000 Americans with acute myocardial infarction (MI) in 2005 (1). Approximately 30–45% of these were STEMI. Excellent societal guideline recommendations exist for STEMI care (2–4)

Key Points

• Age, blood pressure, heart rate, congestive heart failure, and ECG findings allow early risk stratification for patients presenting with acute ST-segment elevating myocardial infarction (STEMI).

• Expeditious reperfusion therapy should be the goal for all patients with STEMI.

• Primary PCI is superior to fibrinolytic therapy if performed in a timely manner (less than 90 min) in an excellent interventional cardiology laboratory.

• Echocardiography should be performed in hemodynamically unstable patients to exclude mechanical complications.

• All patients should receive dual antiplatelet therapy with aspirin for life and clopidogrel for 1 year.

• Patients should receive anticoagulation therapy with either unfractionated heparin, enoxaparin, fondaparinux, or bivalirudin.

• Patients should receive an oral beta-blocker within 24 h unless contraindications exist.

• Aspirin, beta-blockers, statins, and ACE inhibitors have each been shown to reduce long-term mortality.

• Aldosterone blockade is indicated in patients with LVEF ≤40% and either symptomatic heart failure or diabetes mellitus, unless they have renal dysfunction or hyperkalemia.

• Risk stratification should be performed to select high-risk patients for elective coronary artery revascularization and ICD therapy.

• Patients should be referred to a cardiac rehabilitation program subsequent to discharge from hospital.

• Long-term adoption of American Heart Association Step II diet, exercise, and smoking cessation are indicated. Control of hypertension, hyperlipidemia, diabetes mellitus, and weight to target values should be aggressively pursued.