MONDAY, Dec. 17 (HealthDay News) -- Managing patients with acute ST-elevation myocardial infarction should not only be about drugs and devices, but also emphasize an integrated team system of care, according to updated guidelines published online Dec. 10 in Circulation: Journal of the American Heart Association.
Patient management should continue from the emergency medical services to the community hospital to the catheterization team, the report notes. The time to reperfusion should be cut, preferably by performing percutaneous coronary intervention (PCI) if it can be initiated within 90 minutes of patient presentation, otherwise thrombolytics should be given within 30 minutes of presentation. Time from symptom-onset to reperfusion should also be shortened, according to the guidelines.
The document emphasizes changes in anticoagulation protocols and the use of the various available antithrombin agents. Anticoagulation should be maintained for at least 48 hours after initiating thrombolytic therapy, and clopidogrel should be added to aspirin therapy at PCI and continued for one to 12 months depending on stent type. Patients taking cyclooxygenase-2 inhibitors or non-steroidal anti-inflammatory agents except aspirin should discontinue them due to the increased risk of mortality, hypertension and other negative outcomes, according to the recommendations. Beta-blockers should be given during the first 24 hours except in high-risk patients.
The guidelines are an update of guidelines published in 2004 and published jointly by the American Heart Association and the American College of Cardiology. The committee was co-chaired by Elliott M. Antman, M.D., from Brigham and Women's Hospital in Boston.
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