Regardless of the strategy, both entail aggressive utility of medications such as anticoagulants, antiplatelet agents, beta blockers, statins, and possible use of angiotensin-converting enzyme (ACE) inhibitors for appropriate patient populations. [Full Text]. [Full Text]. Available at Eur Heart J. For patients presenting to a non–PCI-capable hospital, if they cannot be transferred to a PCI-capable hospital within 120 minutes, it is very important to rapidly assess the following to reach a decision about administration of fibrinolytic therapy: Even when interhospital transfer times are short, there may be relative advantages to a strategy of immediate fibrinolytic therapy versus any delay to primary PCI for eligible patients who present within the first 1 to 2 hours after symptom onset. Luepker RV, Raczynski JM, Osganian S, et al. [Medline]. [Medline]. Risk score stratification for NSTEMI patients to dictate the appropriate strategy (invasive versus ischemic-guided) and the timing of the strategy (early versus late invasive) in patients with NSTEMI. [2], Fibrinolytic therapy is associated with an excess of strokes, mainly due to cerebral hemorrhage, which is more commonly seen in patients with advanced age, lower weight, female sex, prior cerebrovascular disease, and hypertension on admission. Acute myocardial infarct. Lancet. 29 (2):97-103. Fetal Pediatr Pathol. Vaidya SR, Qamar A, Arora S, Devarapally SR, Kondur A, Kaul P. Culprit versus multivessel coronary intervention in ST-segment elevation myocardial infarction: a meta-analysis of randomized trials. After the initial management and stabilization of the patient in the early and critical phase of acute myocardial infarction (MI), the goals of care for these patients is to restore normal activities, prevent long-term complications, as well as aggressively modify lifestyle and risk factors. Chapter 2 Inferior Wall Myocardial Infarction Key Points Inferior wall myocardial infarction (IMI) is the most common ST-elevation myocardial infarction (STEMI). Special attention should be made in taking the history of whether concomitant use of phosphodiesterase (PDE) inhibitors (eg, sildenafil) has occurred within the last 24 to 72 hours, because this drug combination may lead to life-threatening hypotension. Improved results of surgical management of postinfarction ventricular septal rupture. [106] These findings were demonstrated in the Efficacy and Safety of Subcutaneous Enoxaparin in Non–Q wave Coronary Events (ESSENCE) trial. [116] and the Atorvastatin for Reduction of Myocardial Damage During Angioplasty-Acute Coronary Syndromes (ARMYDA-ACS) trial Circulation. Amgen Inc. FDA approves Amgen's Repatha (evolocumab) to prevent heart attack and stroke [press release]. 2014 Mar 5. 2016 Jul. 2012 Oct. 33 (20):2569-619. O'Riordan M. Another study links testosterone therapy to MI risk. N Engl J Med. [Medline]. 349 (8):733-42. [Medline]. Table 2. Nainggolan L. New US STEMI Guidelines Are More User Friendly. Jeffrey S. New AHA/ACC CVD primary prevention guideline. 92(3):657-71. Ischaemic heart disease, influenza and influenza vaccination: a prospective case control study. 1996 Jul 1, Keeley EC,Boura JA,Grines CL, Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. However, it is more widespread in some regions in Europe and the United Kingdom. Supplemental oxygen by a mask or nasal cannula is indicated only for patients who are breathless, hypoxic (oxygen saturation < 90% or PaO2< 60 mm Hg Falk E, Shah PK, Fuster V. Coronary plaque disruption. 2000 Jan 20. Wang JC, Normand SL, Mauri L, Kuntz RE. The arrow points to a transmural infarct in the posterior wall of the left ventricle, in this short axis slice through the left and right ventricular chambers. FDA study of Medicare patients finds risks lower for stroke and death but higher for gastrointestinal bleeding with Pradaxa (dabigatran) compared to warfarin. 65 (19):e7-e26. Circulation 1999:100(suppl I):I-433 . [Guideline] Levine GN, Bates ER, Blankenship JC, et al. Circulation. Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction. [Medline]. Duration of symptoms is the key modulator of the choice of reperfusion for ST-elevation myocardial infarction. The classic features of inferior STEMI are unmistakable: The hallmark is the presence of ST-segment elevations in the “inferior limb leads” – II, III and aVF. Associations of coronary heart disease risk factors with the intermediate lesion of atherosclerosis in youth. [96]. 2014. N Engl J Med. Extent of LMI was assessed intraoperatively as less than 25%, 25% to 49%, 50% to 75%, and more than 75% of the lateral wall. Wendling P. AHA/ACC issue new performance, quality measures for MI. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. A maintenance dose of aspirin 75-100 mg daily should be continued indefinitely. C-reactive protein is a potent predictor of mortality independently of and in combination with troponin T in acute coronary syndromes: a TIMI 11A substudy. 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