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JACC Vol. 44, No. 3, 2004 August 4, 2004:671–719

Antman et al. Management of Patients With STEMI: Executive Summary

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Figure 5. Algorithm to aid in selection of ICD in patients with STEMI and diminished ejection fraction (EF). Appropriate management path is selected based on LVEF measured at least 1 month after STEMI. These criteria, which are based on published data, form the basis for the full-text guidelines in Section 7.7.1.5. All patients, whether an ICD is implanted or not, should receive medical therapy as outlined in the guidelines. VF indicates ventricular fibrillation; VII, ventricular tachycardia; STEMI, ST-elevation myocardial infarction; NSVT, nonsustained VT; LOE, level of evidence; EPS, electrophysiological studies; LVEF, left ventricular EF.

Class IIa 1. For episodes of pericarditis after STEMI that are not adequately controlled with aspirin, it is reasonable to administer 1 or more of the following: a. Colchicine 0.6 mg every 12 hours orally. (Level of Evidence: B) b. Acetaminophen 500 mg orally every 6 hours. (Level of Evidence: C) Class IIb 1. Nonsteroidal anti-inflammatory drugs may be considered for pain relief; however, they should not be used for extended periods because of their continuous effect on platelet function, an increased risk of myocardial scar thinning, and infarct expansion. (Level of Evidence: B) 2. Corticosteroids might be considered only as a last resort in patients with pericarditis refractory to aspirin or nonsteroidal drugs. Although corticosteroids are effective for pain relief, their use is associated with an increased risk of scar thinning and myocardial rupture. (Level of Evidence: C) Class III 1. Ibuprofen should not be used for pain relief because it blocks the antiplatelet effect of aspirin and can cause

myocardial scar thinning and infarct expansion. (Level of Evidence: B) 2. Recurrent Ischemia/Infarction Class I 1. Patients with recurrent ischemic-type chest discomfort after initial reperfusion therapy for STEMI should undergo escalation of medical therapy with nitrates and beta-blockers to decrease myocardial oxygen demand and reduce ischemia. Intravenous anticoagulation should be initiated if not already accomplished. (Level of Evidence: B) 2. In addition to escalation of medical therapy, patients with recurrent ischemic-type chest discomfort and signs of hemodynamic instability, poor LV function, or a large area of myocardium at risk should be referred urgently for cardiac catheterization and undergo revascularization as needed. Insertion of an IABP should also be considered. (Level of Evidence: C) 3. Patients with recurrent ischemic-type chest discomfort who are considered candidates for revascularization should undergo coronary arteriography and PCI or CABG as dictated by coronary anatomy. (Level of Evidence: B) Class IIa 1. It is reasonable to (re)administer fibrinolytic therapy to patients with recurrent ST elevation and ischemictype chest discomfort who are not considered candi-

ACC/AHA Practice Guidelines ACC/AHA Guidelines for  

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary 672 Antman et al. JACC Vol. 44,...

ACC/AHA Practice Guidelines ACC/AHA Guidelines for  

ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary 672 Antman et al. JACC Vol. 44,...

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