Management of ST-Elevation Myocardial Infarction (STEMI)

Initial Assessment and Immediate Actions

The European Society of Cardiology recommends immediately administering 162-325 mg of non-enteric coated aspirin to all STEMI patients upon first medical contact, and proceeding with urgent reperfusion therapy 1, 2, 3
Obtain a 12-lead ECG within 10 minutes of emergency department arrival for all patients with chest discomfort or STEMI symptoms 3
STEMI is defined as ST-segment elevation >0.1 mV in at least two contiguous precordial or adjacent limb leads, new left bundle branch block, or true posterior MI 4
If the initial ECG is non-diagnostic but clinical suspicion remains high, perform serial ECGs at 5-10 minute intervals 3

The American College of Cardiology recommends primary PCI if first medical contact-to-device time can be achieved within 120 minutes 1, 2
Choose fibrinolysis if primary PCI cannot be performed within 120 minutes of STEMI diagnosis 1, 2, 3

The European Society of Cardiology recommends dual antiplatelet therapy with aspirin plus a potent P2Y12 inhibitor (prasugrel or ticagrelor preferred over clopidogrel) for primary PCI 1, 2, 7
For fibrinolysis, use aspirin plus clopidogrel 1

The American College of Cardiology recommends initiating ACE inhibitors within 24 hours in all patients, particularly those with anterior MI, heart failure, or ejection fraction ≤0.40 8, 5, 7
Continue oral beta-blockers indefinitely in all eligible patients 8, 5, 7

The American College of Cardiology recommends emergency revascularization (PCI or CABG) regardless of time delay from MI onset for cardiogenic shock 5, 7
Intra-aortic balloon counterpulsation for patients not quickly stabilized with pharmacological therapy 5, 7

The European Society of Cardiology recommends routine echocardiography during hospital stay to assess LV and RV function, detect mechanical complications, and exclude LV thrombus 1
Follow-up ECGs at 24 hours and hospital discharge to assess reperfusion success and infarct extent 6