ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)

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Circulation. 2004;110:588-636
doi: 10.1161/01.CIR.0000134791.68010.FA

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(Circulation. 2004;110:588-636.)
© 2004 American Heart Association, Inc.

ACC/AHA Practice Guidelines

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary

A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)

Developed in Collaboration With the Canadian Cardiovascular Society Writing Committee Members: Elliott M. Antman, MD, FACC, FAHA, Chair; Daniel T. Anbe, MD, FACC, FAHA; Paul Wayne Armstrong, MD, FACC, FAHA; Eric R. Bates, MD, FACC, FAHA; Lee A. Green, MD, MPH; Mary Hand, MSPH, RN, FAHA; Judith S. Hochman, MD, FACC, FAHA; Harlan M. Krumholz, MD, FACC, FAHA; Frederick G. Kushner, MD, FACC, FAHA; Gervasio A. Lamas, MD, FACC; Charles J. Mullany, MB, MS, FACC; Joseph P. Ornato, MD, FACC, FAHA; David L. Pearle, MD, FACC, FAHA; Michael A. Sloan, MD, FACC; Sidney C. Smith, Jr, MD, FACC, FAHA

Task Force Members: Elliott M. Antman, MD, FACC, FAHA, Chair; Sidney C. Smith, Jr, MD, FACC, FAHA, Vice-chair; Joseph S. Alpert, MD, FACC, FAHA^*; Jeffrey L. Anderson, MD, FACC, FAHA; David P. Faxon, MD, FACC, FAHA; Valentin Fuster, MD, PhD, FACC, FAHA; Raymond J. Gibbons, MD, FACC, FAHA^*^,; Gabriel Gregoratos, MD, FACC, FAHA^*; Jonathan L. Halperin, MD, FACC, FAHA; Loren F. Hiratzka, MD, FACC, FAHA; Sharon Ann Hunt, MD, FACC, FAHA; Alice K. Jacobs, MD, FACC, FAHA; Joseph P. Ornato, MD, FACC, FAHA

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Table of Contents

I. Introduction

II. Pathology 590

A. Epidemiology590

III. Management Before STEMI 590

A.Identification of Patients at Risk of STEMI590

B.Patient Education for Early Recognitionand Response to STEMI590

IV. Onset of STEMI 592

A. Out-of-HospitalCardiac Arrest 592

V. Prehospital Issues 592

A.Emergency Medical Services Systems 592

B.Prehospital Chest Pain Evaluation and Treatment592

C.Prehospital Fibrinolysis 592

D. PrehospitalDestination Protocols 593

VI. Initial Recognition and Managementin the Emergency Department593

A. OptimalStrategies for Emergency DepartmentTriage 593

B.Initial Patient Evaluation 593

1.History 595

2. PhysicalExamination595

3. Electrocardiogram595

4. Laboratory Examinations595

5. Biomarkers of CardiacDamage 595

a.BedsideTesting for Serum Cardiac Biomarkers 596

6.Imaging 596

C. Management 596

1.Routine Measures 596

a.Oxygen596

b.Nitroglycerin596

c.Analgesia596

d.Aspirin597

e.Beta-Blockers597

f.Reperfusion597

•General Concepts 597

•Selection of Reperfusion Strategy 597

•Pharmacological Reperfusion 598

•Percutaneous Coronary Intervention 600

•Acute Surgical Reperfusion 605

•Patients With STEMI Not Receiving Reperfusion 605

•Assessment of Reperfusion 605

•Ancillary Therapy 605

•Other Pharmacological Measures 607

VII. Hospital Management608

A. Location 608

1.Coronary Care Unit 608

2.Stepdown Unit 608

B. Early, General Measures609

1. Level of Activity609

2. Diet 609

3.Patient Education inthe Hospital Setting 609

4.Analgesia/Anxiolytics609

C. Risk StratificationDuring Early HospitalCourse 609

D. MedicationAssessment 610

1. BetaBlockers . . . [Full Text of this Article]

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Development of Systems of Care for ST-Elevation Myocardial Infarction Patients: The Primary Percutaneous Coronary Intervention (ST-Elevation Myocardial Infarction Receiving) Hospital Perspective
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A Khavandi, K Potts, and P R Walker
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T. J. Kiernan, H. H. Ting, and B. J. Gersh
Facilitated percutaneous coronary intervention: current concepts, promises, and pitfalls
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J. S. de Villiers, T. Anderson, J. D. McMeekin, R. C.M. Leung, M. Traboulsi, and for the Foothills Interventional Cardiology Servic
Expedited transfer for primary percutaneous coronary intervention: a program evaluation
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R. K. Riezebos, K. de Man, M. S. Patterson, and G. S. de Ruiter
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C. Rosendorff, H. R. Black, C. P. Cannon, B. J. Gersh, J. Gore, J. L. Izzo Jr, N. M. Kaplan, C. M. O'Connor, P. T. O'Gara, and S. Oparil
Treatment of Hypertension in the Prevention and Management of Ischemic Heart Disease: A Scientific Statement From the American Heart Association Council for High Blood Pressure Research and the Councils on Clinical Cardiology and Epidemiology and Prevention
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K. Parakh, D. E. Bush, R. C. Ziegelstein, B. D. Thombs, and J. A. Fauerbach
Mortality and Adherence to Pharmacotherapy After Acute Myocardial Infarction
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K. A. A. Fox, P. G. Steg, K. A. Eagle, S. G. Goodman, F. A. Anderson Jr, C. B. Granger, M. D. Flather, A. Budaj, A. Quill, J. M. Gore, et al.
Decline in Rates of Death and Heart Failure in Acute Coronary Syndromes, 1999-2006
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G. E. Kikano and M. T. Brown
Antiplatelet Therapy for Atherothrombotic Disease: An Update for the Primary Care Physician
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J. R. Anderson, N. Nagajothi, J.-L. E. Velazquez-Cecena, S. Khosla, B. Wong, O. Erdogan, L. De Luca, F. Tomai, D. Chua, A. Lo, et al.
Persistent Coronary Occlusion after Myocardial Infarction
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The TRIUMPH Investigators
Effect of Tilarginine Acetate in Patients With Acute Myocardial Infarction and Cardiogenic Shock: The TRIUMPH Randomized Controlled Trial
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D. C. Brown, S. Szabo, T. Oikonomopoulos, H. M. Hoffmeister, A. S. Kashyap, S. Kashyap, K. P. Anand, E. C. Keeley, and L. D. Hillis
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W. E. Boden, R. A. O'Rourke, K. K. Teo, P. M. Hartigan, D. J. Maron, W. J. Kostuk, M. Knudtson, M. Dada, P. Casperson, C. L. Harris, et al.
Optimal Medical Therapy with or without PCI for Stable Coronary Disease
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A. Lerman, D. R. Holmes, J. Herrmann, and B. J. Gersh
Microcirculatory dysfunction in ST-elevation myocardial infarction: cause, consequence, or both?
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J. N. Rasmussen, A. Chong, and D. A. Alter
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P. G. Steg, J. Lopez-Sendon, E. Lopez de Sa, S. G. Goodman, J. M. Gore, F. A. Anderson Jr, D. Himbert, J. Allegrone, F. Van de Werf, and for the GRACE Investigators
External Validity of Clinical Trials in Acute Myocardial Infarction
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E. C. Keeley and L. D. Hillis
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D. C. Goff Jr, L. Brass, L. T. Braun, J. B. Croft, J. D. Flesch, F. G.R. Fowkes, Y. Hong, V. Howard, S. Huston, S. F. Jencks, et al.
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				P. Bogaty Duration of Symptoms Is Not Always the Key Modulator of the Choice of Reperfusion for ST-Elevation Myocardial Infarction Circulation, March 10, 2009; 119(9): 1304 - 1310. [Full Text] [PDF]

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				WRITING COMMITTEE MEMBERS, F. A. Masoudi, R. O. Bonow, R. G. Brindis, C. P. Cannon, J. DeBuhr, S. Fitzgerald, P. A. Heidenreich, K. K.L. Ho, H. M. Krumholz, et al. ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy: A Report of the ACC/AHA Task Force on Performance Measures (Work Group to Address the Challenges of Performance Measurement and Reperfusion Therapy) Circulation, December 9, 2008; 118(24): 2649 - 2661. [Full Text] [PDF]

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