STEMI and Out-of-Hospital Cardiac Arrest

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Acute Coronary Syndrome Main Page

ST Elevation Myocardial Infarction Microchapters


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Pathophysiology of Vessel Occlusion
Pathophysiology of Reperfusion
Gross Pathology


Differentiating ST elevation myocardial infarction from other Diseases

Epidemiology and Demographics

Risk Factors


Natural History and Complications

Risk Stratification and Prognosis



Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings


EKG Examples

Chest X Ray

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Coronary Angiography


Pre-Hospital Care

Initial Care

Beta Blockers
The coronary care unit
The step down unit
STEMI and Out-of-Hospital Cardiac Arrest
Pharmacologic Reperfusion
Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI)
Reperfusion at a Non–PCI-Capable Hospital:Recommendations
Mechanical Reperfusion
The importance of reducing Door-to-Balloon times
Primary PCI
Adjunctive and Rescue PCI
Rescue PCI
Facilitated PCI
Adjunctive PCI
Management of Patients Who Were Not Reperfused
Assessing Success of Reperfusion
Antithrombin Therapy
Antithrombin therapy
Unfractionated heparin
Low Molecular Weight Heparinoid Therapy
Direct Thrombin Inhibitor Therapy
Factor Xa Inhibition
DVT prophylaxis
Long term anticoagulation
Antiplatelet Agents
Thienopyridine Therapy
Glycoprotein IIbIIIa Inhibition
Other Initial Therapy
Inhibition of the Renin-Angiotensin-Aldosterone System
Magnesium Therapy
Glucose Control
Calcium Channel Blocker Therapy
Lipid Management

Pre-Discharge Care

Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT

Post Hospitalization Plan of Care

Long-Term Medical Therapy and Secondary Prevention

Inhibition of the Renin-Angiotensin-Aldosterone System
Cardiac Rehabilitation
Pacemaker Implantation
Long Term Anticoagulation
Implantable Cardioverter Defibrillator
ICD implantation within 40 days of myocardial infarction
ICD within 90 days of revascularization

Case Studies

Case #1

Case #2

Case #3

Case #4

Case #5

STEMI and Out-of-Hospital Cardiac Arrest On the Web

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FDA on STEMI and Out-of-Hospital Cardiac Arrest

CDC on STEMI and Out-of-Hospital Cardiac Arrest

STEMI and Out-of-Hospital Cardiac Arrest in the news

Blogs on STEMI and Out-of-Hospital Cardiac Arrest

Directions to Hospitals Treating ST elevation myocardial infarction

Risk calculators and risk factors for STEMI and Out-of-Hospital Cardiac Arrest

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction (DO NOT EDIT)[1]

Evaluation and Management of Patients With STEMI and Out-of-Hospital Cardiac Arrest (DO NOT EDIT)[1]

Class I
"1. Therapeutic hypothermia should be started as soon as possible in comatose patients with STEMI and out-of-hospital cardiac arrest caused by ventricular fibrillation or pulseless ventricular tachycardia, including patients who undergo primary PCI.[2][3][4] (Level of Evidence: B)"
"2. Immediate angiography and PCI when indicated should be performed in resuscitated out-of-hospital cardiac arrest patients whose initial ECG shows STEMI.[5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] (Level of Evidence: B)"


  1. 1.0 1.1 O'Gara PT, Kushner FG, Ascheim DD; et al. (2012). "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0b013e3182742c84. PMID 23247303. Unknown parameter |month= ignored (help)
  2. Peberdy MA, Callaway CW, Neumar RW; et al. (2010). "Part 9: post-cardiac arrest care: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S768–86. doi:10.1161/CIRCULATIONAHA.110.971002. PMID 20956225. Unknown parameter |month= ignored (help)
  3. Bernard SA, Gray TW, Buist MD; et al. (2002). "Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia". N. Engl. J. Med. 346 (8): 557–63. doi:10.1056/NEJMoa003289. PMID 11856794. Unknown parameter |month= ignored (help)
  4. "Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest". N. Engl. J. Med. 346 (8): 549–56. 2002. doi:10.1056/NEJMoa012689. PMID 11856793. Unknown parameter |month= ignored (help)
  5. Nichol G, Aufderheide TP, Eigel B; et al. (2010). "Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association". Circulation. 121 (5): 709–29. doi:10.1161/CIR.0b013e3181cdb7db. PMID 20075331. Unknown parameter |month= ignored (help)
  6. Bendz B, Eritsland J, Nakstad AR; et al. (2004). "Long-term prognosis after out-of-hospital cardiac arrest and primary percutaneous coronary intervention". Resuscitation. 63 (1): 49–53. doi:10.1016/j.resuscitation.2004.04.006. PMID 15451586. Unknown parameter |month= ignored (help)
  7. Borger van der Burg AE, Bax JJ, Boersma E; et al. (2003). "Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital". Am. J. Cardiol. 91 (7): 785–9. PMID 12667561. Unknown parameter |month= ignored (help)
  8. Bulut S, Aengevaeren WR, Luijten HJ, Verheugt FW (2000). "Successful out-of-hospital cardiopulmonary resuscitation: what is the optimal in-hospital treatment strategy?". Resuscitation. 47 (2): 155–61. PMID 11008153. Unknown parameter |month= ignored (help)
  9. Garot P, Lefevre T, Eltchaninoff H; et al. (2007). "Six-month outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction". Circulation. 115 (11): 1354–62. doi:10.1161/CIRCULATIONAHA.106.657619. PMID 17353440. Unknown parameter |month= ignored (help)
  10. Gorjup V, Radsel P, Kocjancic ST, Erzen D, Noc M (2007). "Acute ST-elevation myocardial infarction after successful cardiopulmonary resuscitation". Resuscitation. 72 (3): 379–85. doi:10.1016/j.resuscitation.2006.07.013. PMID 17161902. Unknown parameter |month= ignored (help)
  11. Hosmane VR, Mustafa NG, Reddy VK; et al. (2009). "Survival and neurologic recovery in patients with ST-segment elevation myocardial infarction resuscitated from cardiac arrest". J. Am. Coll. Cardiol. 53 (5): 409–15. doi:10.1016/j.jacc.2008.08.076. PMID 19179198. Unknown parameter |month= ignored (help)
  12. Kahn JK, Glazier S, Swor R, Savas V, O'Neill WW (1995). "Primary coronary angioplasty for acute myocardial infarction complicated by out-of-hospital cardiac arrest". Am. J. Cardiol. 75 (15): 1069–70. PMID 7747692. Unknown parameter |month= ignored (help)
  13. Keelan PC, Bunch TJ, White RD, Packer DL, Holmes DR (2003). "Early direct coronary angioplasty in survivors of out-of-hospital cardiac arrest". Am. J. Cardiol. 91 (12): 1461–3, A6. PMID 12804734. Unknown parameter |month= ignored (help)
  14. Kern KB, Rahman O (2010). "Emergent percutaneous coronary intervention for resuscitated victims of out-of-hospital cardiac arrest". Catheter Cardiovasc Interv. 75 (4): 616–24. doi:10.1002/ccd.22192. PMID 20049976. Unknown parameter |month= ignored (help)
  15. Marcusohn E, Markusohn E, Roguin A; et al. (2007). "Primary percutaneous coronary intervention after out-of-hospital cardiac arrest: patients and outcomes". Isr. Med. Assoc. J. 9 (4): 257–9. PMID 17491217. Unknown parameter |month= ignored (help)
  16. Pleskot M, Babu A, Hazukova R; et al. (2008). "Out-of-hospital cardiac arrests in patients with acute ST elevation myocardial infarctions in the East Bohemian region over the period 2002-2004". Cardiology. 109 (1): 41–51. doi:10.1159/000105325. PMID 17627108.
  17. Quintero-Moran B, Moreno R, Villarreal S; et al. (2006). "Percutaneous coronary intervention for cardiac arrest secondary to ST-elevation acute myocardial infarction. Influence of immediate paramedical/medical assistance on clinical outcome". J Invasive Cardiol. 18 (6): 269–72. PMID 16751680. Unknown parameter |month= ignored (help)
  18. Richling N, Herkner H, Holzer M, Riedmueller E, Sterz F, Schreiber W (2007). "Thrombolytic therapy vs primary percutaneous intervention after ventricular fibrillation cardiac arrest due to acute ST-segment elevation myocardial infarction and its effect on outcome". Am J Emerg Med. 25 (5): 545–50. doi:10.1016/j.ajem.2006.10.014. PMID 17543659. Unknown parameter |month= ignored (help)
  19. Spaulding CM, Joly LM, Rosenberg A; et al. (1997). "Immediate coronary angiography in survivors of out-of-hospital cardiac arrest". N. Engl. J. Med. 336 (23): 1629–33. doi:10.1056/NEJM199706053362302. PMID 9171064. Unknown parameter |month= ignored (help)
  20. Werling M, Thorén AB, Axelsson C, Herlitz J (2007). "Treatment and outcome in post-resuscitation care after out-of-hospital cardiac arrest when a modern therapeutic approach was introduced". Resuscitation. 73 (1): 40–5. doi:10.1016/j.resuscitation.2006.08.018. PMID 17241730. Unknown parameter |month= ignored (help)

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