Complications After STEMI
Cardiogenic Shock
ÎÎEmergency revascularization with either PCI or CABG is recommended
in suitable patients with cardiogenic shock due to pump failure after
STEMI irrespective of the time delay from MI onset. (I-B)
ÎÎIn the absence of contraindications, fibrinolytic therapy should be
administered to patients with STEMI and cardiogenic shock who are
unsuitable candidates for either PCI or CABG. (I-B)
ÎÎThe use of intra-aortic balloon pump (IABP) counterpulsation can be
useful for patients with cardiogenic shock after STEMI who do not
quickly stabilize with pharmacological therapy. (IIa-B)
ÎÎAlternative LV assist devices for circulatory support may be
considered in patients with refractory cardiogenic shock. (IIb-C)
Implantable Cardioverter-Defibrillator Therapy Before Discharge
ÎÎImplantable cardioverter-defibrillator (ICD) therapy is indicated before
discharge in patients who develop sustained VT/VF more than 48
hours after STEMI, provided the arrhythmia is not due to transient or
reversible ischemia, reinfarction, or metabolic abnormalities. (I-B)
Bradycardia, AV Block, and Intraventricular Conduction Defects
Pacing in STEMI
ÎÎTemporary pacing is indicated for symptomatic bradyarrhythmias
unresponsive to medical treatment. (I-C)
Pericarditis
ÎÎAspirin is recommended for treatment of pericarditis after STEMI. (I-B)
ÎAdministration of acetaminophen, colchicine, or narcotic analgesics may
Î
be reasonable if aspirin, even in higher doses, is not effective. (IIb-C)
ÎGlucocorticoids and nonsteroidal anti-inflammatory drugs are potentially
Î
harmful for treatment of pericarditis after STEMI. (III-B: Harm)
Table 13. Selected Risk Factors for Bleeding in Patients
With ACS
Advanced age (>75 y)
Presentation with STEMI or NSTEMI (vs. UA)
Female sex
Severe renal dysfunction (CrCl <30 mL/min)
HF or shock
Elevated white blood cell count
Diabetes
Use of fibrinolytic therapy
Body size
Invasive strategy
History of GI bleeding
Inappropriate dosing of antithrombotic medications
Anemia
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