Management of Acute Myocardial Infarction

Antithrombotic Therapy

The European Society of Cardiology recommends dual antiplatelet therapy (DAPT) with aspirin plus a potent P2Y12 inhibitor (ticagrelor or prasugrel) for 12 months after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) 1, 2
Aspirin (75-100 mg daily) is the foundation antiplatelet agent and should be administered as soon as possible in all AMI patients without contraindications, as recommended by the European Society of Cardiology 2, 3
P2Y12 inhibitors, such as ticagrelor and prasugrel, are preferred over clopidogrel due to their more potent antiplatelet effects and faster onset of action, according to the European Society of Cardiology 1, 2
Fondaparinux is not recommended for primary PCI, as stated by the European Society of Cardiology 2, 3
Enoxaparin (intravenous followed by subcutaneous) is preferred over unfractionated heparin in patients receiving fibrinolytic therapy, as recommended by the European Society of Cardiology 2, 4

Primary PCI is the preferred reperfusion strategy when available in a timely manner, according to the European Society of Cardiology 2, 3
Fibrinolytic therapy is recommended within 12 hours of symptom onset when primary PCI cannot be performed in a timely manner, as stated by the European Society of Cardiology 2, 3
A fibrin-specific agent (tenecteplase, alteplase, or reteplase) is recommended for fibrinolytic therapy, according to the European Society of Cardiology 2, 4

Oral beta-blockers are indicated in patients with heart failure and/or left ventricular ejection fraction (LVEF) <40% unless contraindicated, as recommended by the European Society of Cardiology 2, 4
High-intensity statin therapy should be started as early as possible and maintained long-term, according to the European Society of Cardiology 2, 4
An LDL-C goal of <1.8 mmol/L (70 mg/dL) or a reduction of at least 50% if baseline LDL-C is between 1.8-3.5 mmol/L is recommended, as stated by the European Society of Cardiology 2, 4
ACE inhibitors are recommended within the first 24 hours of ST-elevation myocardial infarction (STEMI) in patients with evidence of heart failure, LV systolic dysfunction, diabetes, or anterior infarct, according to the European Society of Cardiology 2, 4
Mineralocorticoid receptor antagonists (MRAs) are recommended in patients with an ejection fraction <40% and heart failure or diabetes, as stated by the European Society of Cardiology 4