ACC/AHA 2009 STEMI/PCI Guidelines
ACC/AHA Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction (STEMI) and the ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (PCI)
J. Am. Coll. Cardiol. 2009;54;2205-2241
Glycoprotein IIb/IIIa Antagonists in STEMI
- It is reasonable to start treatment with GP IIb/IIIa antagonists (abciximab, tirofiban and eptifibatide) at the time of primary PCI in selected patients with STEMI
A loading dose of thienopyridine is recommended for STEMI patients for whom PCI is planned.
Regimens should be one of the following:
Parenteral Anticoagulants in STEMI
- Clopidogrel at least 300 to 600 mg should be given as early as possible before or at the time of primary or non-primary PCI.
- Prasugrel 60 mg should be given as soon as possible for primary PCI.
- For prior treatment with UFH, additional boluses of UFH should be administered as needed to maintain therapeutic activated clotting time levels, taking into account whether GP IIb/IIIa antagonists have been administered; or
- Bivalirudin is useful as support for primary PCI with or without prior treatment with heparin.
High Risk Definition:
- Defined in CARESS-in-AMI as STEMI patients with one or more high-risk features:
– extensive ST-segment elevation
– new-onset left BBB
– previous MI
– Killip class >2
– LVEF <35% for inferior MI
Anterior MI alone with 2 mm or more ST-elevation in 2 or more leads qualifies
- Defined in TRANSFER-AMI as >2 mm ST-segment elevation in 2 anterior leads or ST elevation at least 1 mm in inferior leads with at least one of the following:
– SBP <100 mmHg
– heart rate >100 bpm
– Killip Class II-III
– >2 mm of ST-segment depression in the anterior leads
– >1mm of ST elevation in right-sided lead V4
ACC/AHA 2007 Guidelines for UA/NSTEMI