ST elevation myocardial infarction management of patients who were not reperfused: Difference between revisions
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[[image:FibrinolyticTxvsNoRep.jpg|none|300px|<ref name="pmid12719207">{{cite journal |author=Stenestrand U, Wallentin L |title=Fibrinolytic therapy in patients 75 years and older with ST-segment-elevation myocardial infarction: one-year follow-up of a large prospective cohort |journal=Arch. Intern. Med. |volume=163 |issue=8 |pages=965–71 |year=2003 |month=April |pmid=12719207 |doi=10.1001/archinte.163.8.965 |url=}}</ref>]] | [[image:FibrinolyticTxvsNoRep.jpg|none|300px|<ref name="pmid12719207">{{cite journal |author=Stenestrand U, Wallentin L |title=Fibrinolytic therapy in patients 75 years and older with ST-segment-elevation myocardial infarction: one-year follow-up of a large prospective cohort |journal=Arch. Intern. Med. |volume=163 |issue=8 |pages=965–71 |year=2003 |month=April |pmid=12719207 |doi=10.1001/archinte.163.8.965 |url=}}</ref>]] | ||
Adjusted probability of death or cerebral bleeding in relation to fibrinolytic therapy in patients with [[ST elevation myocardial infarction]] (STEMI) who were 75 years or older (dotted line) versus that among patients with STEMI not receiving fibrinolysis (solid line). At 30 days and 1 year this was 23% and 32% versus 26% and 36%, respectively. | Adjusted probability of death or cerebral bleeding in relation to fibrinolytic therapy in patients with [[ST elevation myocardial infarction]] (STEMI) who were 75 years or older (dotted line) versus that among patients with STEMI not receiving fibrinolysis (solid line). At 30 days and 1 year this was 23% and 32% versus 26% and 36%, respectively. | ||
==PCI After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion<ref name="pmid19942100">{{cite journal |author=Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO |title=2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines |journal=[[Journal of the American College of Cardiology]] |volume=54 |issue=23|pages=2205–41 |year=2009 |month=December |pmid=19942100 |doi=10.1016/j.jacc.2009.10.015|url=http://linkinghub.elsevier.com/retrieve/pii/S0735-1097(09)03518-9|accessdate=2011-12-06}}</ref> == | |||
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | |||
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<nowiki>"</nowiki>'''1.''' In patients whose anatomy is suitable, [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] should be performed when there is objective evidence of recurrent [[MI]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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<nowiki>"</nowiki>'''2.''' In patients whose anatomy is suitable, [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] should be performed for moderate or severe spontaneous or provocable [[myocardial ischemia]] during recovery from STEMI. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
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<nowiki>"</nowiki>'''3.''' In patients whose anatomy is suitable, [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] should be performed for [[cardiogenic shock]] or hemodynamic instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''<nowiki>"</nowiki> | |||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | |||
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<nowiki>"</nowiki>'''1.''' It is reasonable to perform routine [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] in patients with [[EF|LV ejection fraction]] less than or equal to 0.40, [[heart failure]], or serious [[ventricular arrhythmias]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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<nowiki>"</nowiki>'''2.''' It is reasonable to perform [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]] when there is documented clinical [[heart failure]] during the acute episode, even though subsequent evaluation shows preserved LV function ([[EF|LV ejection fraction]]greater than 0.40). ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | |||
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<nowiki>"</nowiki>'''1.''' [[ST elevation myocardial infarction facilitated percutaneous coronary intervention|PCI]]might be considered as part of an invasive strategy after [[ST elevation myocardial infarction fibrinolytic therapy|fibrinolytic therapy]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | |||
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==ACC/AHA Guidelines (DO NOT EDIT)<ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>== | ==ACC/AHA Guidelines (DO NOT EDIT)<ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>== |
Revision as of 18:17, 9 October 2012
ST Elevation Myocardial Infarction Microchapters |
Differentiating ST elevation myocardial infarction from other Diseases |
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ST elevation myocardial infarction management of patients who were not reperfused On the Web |
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Blogs on ST elevation myocardial infarction management of patients who were not reperfused |
Directions to Hospitals Treating ST elevation myocardial infarction |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor-In-Chief:; Cafer Zorkun, M.D., Ph.D. [2]
Overview
STEMI patients who do not receive reperfusion therapy can be stratified for a differed mortality risk than those who do. The ACC/AHA guidelines recommend specific guidelines for care in this patient population.
Clinical Trial Data
Adjusted probability of death or cerebral bleeding in relation to fibrinolytic therapy in patients with ST elevation myocardial infarction (STEMI) who were 75 years or older (dotted line) versus that among patients with STEMI not receiving fibrinolysis (solid line). At 30 days and 1 year this was 23% and 32% versus 26% and 36%, respectively.
PCI After Successful Fibrinolysis or for Patients Not Undergoing Primary Reperfusion[2]
Class I |
"1. In patients whose anatomy is suitable, PCI should be performed when there is objective evidence of recurrent MI. (Level of Evidence: C)" |
"2. In patients whose anatomy is suitable, PCI should be performed for moderate or severe spontaneous or provocable myocardial ischemia during recovery from STEMI. (Level of Evidence: B)" |
"3. In patients whose anatomy is suitable, PCI should be performed for cardiogenic shock or hemodynamic instability. (Level of Evidence: B)" |
Class IIa |
"1. It is reasonable to perform routine PCI in patients with LV ejection fraction less than or equal to 0.40, heart failure, or serious ventricular arrhythmias. (Level of Evidence: C)" |
"2. It is reasonable to perform PCI when there is documented clinical heart failure during the acute episode, even though subsequent evaluation shows preserved LV function (LV ejection fractiongreater than 0.40). (Level of Evidence: C)" |
Class IIb |
"1. PCImight be considered as part of an invasive strategy after fibrinolytic therapy. (Level of Evidence: C)" |
ACC/AHA Guidelines (DO NOT EDIT)[3]
“ |
Class I1. It is reasonable for patients with STEMI who do not undergo reperfusion therapy to be treated with anticoagulant therapy (non-UFH regimen) for the duration of the index hospitalization, up to 8 days. (Level of Evidence: B) Convenient strategies that can be used include those with LMWH (Level of Evidence: C) or fondaparinux (Level of Evidence: B) using the same dosing regimens as for patients who receive fibrinolytic therapy. |
” |
Sources
- The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [4]
- The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [3]
Related Chapters
- The STEMI Living Guidelines: Vote on current recommendations and suggest revisions to the guidelines
References
- ↑ Stenestrand U, Wallentin L (2003). "Fibrinolytic therapy in patients 75 years and older with ST-segment-elevation myocardial infarction: one-year follow-up of a large prospective cohort". Arch. Intern. Med. 163 (8): 965–71. doi:10.1001/archinte.163.8.965. PMID 12719207. Unknown parameter
|month=
ignored (help) - ↑ Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE, Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA, Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams DO (2009). "2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Journal of the American College of Cardiology. 54 (23): 2205–41. doi:10.1016/j.jacc.2009.10.015. PMID 19942100. Retrieved 2011-12-06. Unknown parameter
|month=
ignored (help) - ↑ 3.0 3.1 Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. Unknown parameter
|month=
ignored (help) - ↑ Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869. Unknown parameter
|month=
ignored (help)