Risk Assessment After STEMI
Use of Noninvasive Testing for Ischemia Before Discharge
ÎÎNoninvasive testing for ischemia should be performed before
discharge to assess the presence and extent of inducible ischemia in
patients with STEMI who have not had coronary angiography and do
not have high-risk clinical features for which coronary angiography
would be warranted. (I-B)
ÎÎNoninvasive testing for ischemia might be considered before
discharge to evaluate the functional significance of a noninfarct artery
stenosis previously identified at angiography. (IIb-C)
ÎÎNoninvasive testing for ischemia might be considered before
discharge to guide the postdischarge exercise prescription. (IIb-C)
Assessment of LV Function
ÎÎLeft ventricular ejection fraction (LVEF) should be measured in all
patients with STEMI. (I-C)
Assessment of Risk for Sudden Cardiac Death (SCD)
ÎÎPatients with an initially reduced LVEF who are possible candidates
for ICD therapy should undergo reevaluation of LVEF 40 or more days
after discharge. (I-B)
Posthospitalization Plan Of Care
ÎÎPosthospital systems of care designed to prevent hospital
readmissions should be used to facilitate the transition to effective,
coordinated outpatient care for all patients with STEMI. (I-B)
ÎÎExercise-based cardiac rehabilitation/secondary prevention programs
are recommended for patients with STEMI. (I-B)
ÎÎA clear, detailed, and evidence-based plan of care that promotes
medication adherence, timely follow-up with the healthcare team,
appropriate dietary and physical activities, and compliance with
interventions for secondary prevention should be provided to patients
with STEMI. (I-C)
ÎÎEncouragement and advice to stop smoking and to avoid secondhand
smoke should be provided to patients with STEMI. (I-A)
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