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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
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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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
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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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
3. Emergency care
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Relief of pain, breathlessness and anxiety
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Cardiac arrest
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Components of delay in STEMI and idealtime intervals for intervention
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Prehospital and in-hospital management, andreperfusion strategies within 24 h of FMC
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Logistics of pre-hospital care
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Logistics of pre-hospital care, cont
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Reperfusion therapy
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Important delays and treatment goals in themanagement of acute STEMI
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Procedural aspects of primary PCI
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Periprocedural anti thrombotic medication inprimary PCI
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Periprocedural anti thrombotic medication inprimary PCI, cont
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Periprocedural anti thrombotic medication inprimary PCI, cont
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Initial dosing of anti thrombotic agents in patients withchronic kidney disease, estimated CrCl
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
4. Management during hospitalization
and at discharge
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Logistical issues during hospital stay
C
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
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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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Routine therapies in the acute, subacute and long term phase of STEMI
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www.escardio.org/guidelines European Heart Journal 2012 - doi:10.1093/eurheartj/ehs215
Routine therapies in the acute, subacute and long term phase of STEMI
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