Principles of management of STEMI
ST elevation myocardial infarction (STEMI) is a life-threatening event usually caused by acute thrombotic occlusion of a coronary artery. If the coronary occlusion is not resolved and blood flow is not restored, myocardial infarction will progress over the next 6 to 12 hours. Emergency treatment of a STEMI aims to reperfuse the ischaemic myocardium, minimise infarct size, relieve symptoms, prevent complications and improve outcomes.
The recommendations in this topic refer to Type 1 myocardial infarction; Type 2 myocardial infarction should be treated according to the cause. See Classification of coronary ischaemic syndromes for information on Type 1 and Type 2 myocardial infarctions.
All patients with a STEMI should be immediately treated with dual antiplatelet therapy and have emergency reperfusion therapy arranged, either with primary percutaneous coronary intervention (PCI) or, if primary PCI is unavailable, thrombolytic therapy.
Further management of a STEMI is based on the clinical course and the findings at coronary angiography (if performed). Following a STEMI, most patients benefit from long-term combination drug therapy with an antiplatelet drug, a statin, an angiotensin converting enzyme inhibitor (ACEI) (or angiotensin II receptor blocker [ARB]) and a beta blocker; see Long-term management of acute coronary syndromes.
See Overview of management of ST elevation myocardial infarction (STEMI) for an overview of the management of STEMI.
PCI = percutaneous coronary intervention; STEMI = ST elevation myocardial infarction