Treatment
Routine Medical Therapies (Table 12)
Beta Blockers
ÎÎOral beta blockers should be initiated in the first 24 hours in patients
with STEMI who do not have any of the following:
• signs of HF
• evidence of a low output state
• increased risk for cardiogenic shock
• other contraindications to use of oral beta blockers:
▶▶ PR interval >0.24 seconds
▶▶ second- or third-degree heart block
▶▶ active asthma or reactive airway disease). (I-B)
Note: Risk factors for cardiogenic shock (the greater the number of risk factors present,
the higher the risk of developing cardiogenic shock) are age >70 years, SBP <120 mm
Hg, sinus tachycardia >110 bpm or heart rate <60 bpm, and increased time since onset
of symptoms of STEMI.
ÎÎBeta blockers should be continued during and after hospitalization for
all patients with STEMI and with no contraindications to their use. (I-B)
ÎÎPatients with initial contraindications to the use of beta blockers in
the first 24 hours after STEMI should be reevaluated to determine
their subsequent eligibility. (I-C)
ÎÎIt is reasonable to administer intravenous beta blockers at the time of
presentation to patients with STEMI and no contraindications to their
use who are hypertensive or have ongoing ischemia. (IIa-B)
Renin-Angiotensin-Aldosterone System Inhibitors
ÎÎAn angiotensin-converting enzyme (ACE) inhibitor should be
administered within the first 24 hours to all patients with STEMI
with anterior location, HF, or ejection fraction (EF) ≤0.40, unless
contraindicated. (I-A)
ÎAn angiotensin receptor blocker (ARB) should be given to patients with
Î
STEMI who have indications for but are intolerant of ACE inhibitors. (I-B)
ÎÎAn aldosterone antagonist should be given to patients with STEMI and
no contraindications who are already receiving an ACE inhibitor and
beta blocker and who have an EF ≤0.40 and either symptomatic HF or
diabetes mellitus. (I-B)
ÎÎACE inhibitors are reasonable for all patients with STEMI and no
contraindications to their use. (IIa-A)
Lipid Management
ÎÎHigh-intensity statin therapy should be initiated or continued in all
patients with STEMI and no contraindications to its use. (I-B)
ÎÎIt is reasonable to obtain a fasting lipid profile in patients with STEMI,
preferably within 24 hours of presentation. (IIa-C)
20
