Acute Myocardial Infarction Management
Initial Treatment
- The European Society of Cardiology recommends immediate reperfusion therapy via primary PCI (if available within 120 minutes) or fibrinolytic therapy (if PCI cannot be performed timely) combined with aspirin, anticoagulation, and beta-blockers to reduce mortality and morbidity in patients with myocardial infarction 1, 2
- The American College of Cardiology suggests that oxygen should be administered via nasal prongs only if SaO₂ < 90%, and routine oxygen should be avoided in non-hypoxemic patients as hyperoxia may increase myocardial injury 3
- Aspirin 160-325 mg should be given orally (chewed and swallowed for faster absorption), unless systolic BP < 90 mmHg or contraindicated, as recommended by the American College of Cardiology 3, 5, 2
Reperfusion Strategy
- Primary PCI is the preferred reperfusion strategy when it can be performed within 120 minutes of STEMI diagnosis by experienced operators, according to the European Heart Journal 1, 2
- The American College of Cardiology recommends that fibrin-specific agents (tenecteplase, alteplase, or reteplase) should be used for fibrinolytic therapy if primary PCI cannot be performed within 120 minutes 1, 2
Pharmacological Management
- Beta-blockers should be initiated early, provided no contraindications, to reduce morbidity and mortality, as recommended by the American College of Cardiology 8, 6
- The American College of Cardiology suggests that intravenous nitroglycerin should be used for 24-48 hours, but avoided in patients with hypotension, bradycardia, excessive tachycardia, or right ventricular involvement 8, 6, 9
Long-Term Management
- The European Society of Cardiology recommends that aspirin 75-100 mg should be taken daily indefinitely, and dual antiplatelet therapy (aspirin plus ticagrelor or prasugrel, or clopidogrel if unavailable/contraindicated) should be used for 12 months after PCI 1, 2
- The American College of Cardiology suggests that beta-blockers should be taken indefinitely, and ACE inhibitors should be used at selected dose indefinitely in patients with heart failure, LVEF dysfunction, diabetes, or anterior infarction 8, 9