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ST-Elevation Myocardial Infarction (STEMI) (ACC)

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Table 12. Selected Routine Medical Therapies Indications Dose/Administration Beta-Receptor Antagonists Oral: Individualize: •  All patients without •  Metoprolol tartrate contraindication 25-50 mg every 6-12 h IV: orally, then transition over •  Patients with next 2-3 d to bid dosing refractory of metoprolol tartrate hypertension or to daily metoprolol or ongoing succinate; titrate to ischemia without daily dose of 200 mg as contraindication tolerated •  Carvedilol 6.25 mg bid, titrate to 25 mg bid as tolerated •  Metoprolol tartrate IV 5 mg every 5 min as tolerated up to 3 doses; titrate to heart rate and BP Avoid/Caution Signs of HF •  Low output state •  Increased risk of cardiogenic shock •  Prolonged first-degree or high-grade atrioventricular (AV) block •  Reactive airways disease ACE Inhibitors For patients with anterior infarction, post-MI LV systolic dysfunction (EF ≤0.40) or HF •  May be given routinely to all patients without contraindication Individualize: •  Lisinopril 2.5-5 mg/d to start; titrate to 10 mg/d or higher as tolerated •  Captopril 6.25-12.5 mg tid to start; titrate to 25-50 mg tid as tolerated •  Ramipril 2.5 mg bid to start; titrate to 5 mg bid as tolerated •  Trandolapril test dose 0.5 mg; titrate up to 4 mg daily as tolerated •  Hypotension •  Renal failure •  Hyperkalemia •  Valsartan 20 mg bid to start; titrate to 160 mg bid as tolerated •  Hypotension •  Renal failure •  Hyperkalemia •  High-dose atorvastatin 80 mg daily •  Caution with drugs metabolized via CYP3A4, fibrates •  Monitor for myopathy, hepatic toxicity •  Combine with diet and lifestyle therapies •  Adjust dose as dictated by targets for low-density lipoprotein (LDL) cholesterol and non-HDL cholesterol reduction ARB For patients intolerant of ACE inhibitors Statins All patients without contraindications 21

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