[Treatment of ST segment elevation myocardial infarctions according to the guidelines]

Abstract

The guidelines "Akutes Koronarsyndrom" published by the German Society of Cardiology, "Management of acute myocardial infarction in patients presenting with ST-segment elevation", and "Guidelines for percutaneous coronary interventions" published by the European Society of Cardiology evaluate diagnostic tools and treatment strategies for ST segment elevation myocardial infarctions. These guidelines offer evidence-based recommendations and allow a standardized therapeutic approach thereby improving the patient's treatment and reducing the mortality. The optimal care for patients presenting with ST segment elevation myocardial infarctions consists of a prehospital phase where an immediate diagnosis should be reached by means of a twelve-channel ECG followed by basic medical treatment with administration of acetylsalicylic acid, heparin, beta-blocker, and nitrates by an emergency physician. The hospital phase can be optimized by integrated myocardial infarction networks with coronary care units offering primary percutaneous coronary interventions (PCIs) and adjuvant medical treatment including the administration of glycoprotein IIb/IIIa inhibitors. If the onset of symptoms is < 3 h and the transportation time to a coronary care unit > 90 min, the indication of primary fibrinolysis should be given by the emergency physician. If fibrinolysis fails, there is a clear indication for rescue PCI. Even with successful thrombolysis PCI should be performed within 24 h. A dual oral antithrombotic therapy starting immediately after diagnosis with a loading dose of 600 mg clopidogrel should be continued with 75 mg/d clopidogrel for 9-12 months on top of 100 mg/d acetylsalicylic acid.