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Year : 2006  |  Volume : 7  |  Issue : 1  |  Page : 15-25 Table of Contents     

Guidelines on the management of acute coronary syndromes in patients presenting with persistent ST-Segment elevation


Date of Web Publication17-Jun-2010

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How to cite this article:
Sulaiman KJ, Abdulqader F, Al-Khaja NM, Al Mahmeed WA, Al Rashdan IR, Al-Suwaidi JM, Amin HE. Guidelines on the management of acute coronary syndromes in patients presenting with persistent ST-Segment elevation. Heart Views 2006;7:15-25

How to cite this URL:
Sulaiman KJ, Abdulqader F, Al-Khaja NM, Al Mahmeed WA, Al Rashdan IR, Al-Suwaidi JM, Amin HE. Guidelines on the management of acute coronary syndromes in patients presenting with persistent ST-Segment elevation. Heart Views [serial online] 2006 [cited 2023 Dec 2];7:15-25. Available from: https://www.heartviews.org/text.asp?2006/7/1/15/63893

   Introduction Top

Acute Coronary Syndromes comprise a spectrum of increasingly severe ischemic conditions, including unstable angina, non ST-elevation myocardial infarction (NSTEMI)and ST-elevation myocardial infarction (STEMI).

In the Gulf, STEMI represents 49% of Acute Coronary Syndromes. The majority of patients are males (85%), who on average are younger than females (58 years vs 62 years). According to the current practice, 75% of the patients receive thrombolytic therapy, while primary PTCA is performed in 5% of patients only. 54% of these patients are diabetics; 38% are hypertensives; 25% are smokers and 30% have hyperlipidemia.

Over the past few years, considerable improvement has occurred in the care for patients with STEMI. Newer and more sensitive and specific biochemical markers for the diagnosis of AMI were introduced which promoted the American College of Cardiology, American Heart Association and the European Society of Cardiology to redefine MI in 2002. Furthermore, newer therapeutic modalities including newer fibrinolytic, antithrombic and antiplatetelet agents were introduced. The Gulf Heart Association has recently published guidelines for the management of patients with acute coronary syndrome without STEMI elevation; Here in the GHA working group for the study of STEMI publishes guidelines for the management of STEMI adopted from the recently updated ACC/AHA guidelines, modified on the basis of more recent data and tailored to the need of our patients.

These guidelines refer to the management of patients with STEMI. The guidelines should be used as "Guidelines", which will apply to the majority of cases.

However it should be appreciated, that specific findings in individual patients may and should result in deviation from the proposed strategy. for every patient, the physician should make an individual decision taking into account the patient's history, presentation, findings during observation or investigation in hospital, and the available treatment facilities.

[Additional file 1]

   Initial Recognition and Management in the Emergency Department Top

Emergency Department Algorithm/For Patients With ACS/For Patients With Symptoms and Signs of STEMI

[Additional file 2]

   Brief Physical Examination in Emergency Department Top

  1. Airway, Breathing, Circulation (ABC)
  2. Vital signs, general observation
  3. Presence or absence of jugular venous distension
  4. Pulmonary auscultation for rales
  5. Cardiac auscultation for murmurs and gallops
  6. Presence or absence of stroke
  7. Presence or absence of pulses
  8. Presence or absence of systemic hypoperfusion (cool, clammy, pale, ashen)

   Differential Diagnosis of STEMI Top

[Additional file 3]

   Assessment of Reperfusion Options for Patients With STEMI Top

Step 1: Assess Time and Risk

  • Time since onset of symptoms
  • Risk of STEMI
  • Risk of fibrinolysis
  • Time required for transport to a skilled PCI laboratory
Step 2: Determine Whether Fibrinolysis or an Invasive Strategy Is Preferred

If presentation is less than 3 hours and there is no delay to an invasive strategy, there is no preference for either strategy

[Additional file 4]

   Contraindications and Cautions for Fibrinolysis in STEMI* Top

[Additional file 5]

   Pharmacological Support During Primary PCI Top

[Additional file 6]

   Laboratory Evaluations for Management of STEMI Top

Serum biomarkers for cardiac damage

(do not wait for results before implementing reperfusion strategy)

Complete blood count with platelet count

INR (international normalized ratio)

Activated partial thromboplastin time

Electrolytes and magnesium

BUN (blood urea nitrogen)



Serum lipids

   Biochemical Markers Top

[Additional file 7]

   Acute CCU Management Top

Sample Admitting Orders for Patients With STEMI

[Additional file 8]

   Emergency Management of Complicated STEMI: Top

[Additional file 9]

   Characteristics of Ventricular Septal Rupture, Rupture of the Ventricular Free Wall, and Papillary Muscle Rupture Top

[Additional file 10]

Algorithm for Management of Recurrent Ischemia/Infarction After STEMI

[Additional file 11]

   Secondary Prevention and Long-term Management Top

[Additional file 12]

   Drugs Commonly Used in the Management of Patients with STEMI Top

[Additional file 13]


   References Top

1."ACC/AHA pocket guidelines for the management of patients with ST-Elevation Myocardial Infarction. July 2004"   Back to cited text no. 1      
2."Addition of Clopidogrel to Aspirin and Fibrinolytic Therapy for Myocardial Infarction with ST-Segment Elevation. The CLARITY TIMI-28 Investigators. N Engl J Med 2005;352."   Back to cited text no. 2      
3."Addition of clopidogrel to aspirin in 45 852 patients with acute myocardial infarction: randomized placebo-controlled trial. COMMIT (ClOpidogrel and Metoprolol in Myocardial Infarction Trial) collaborative group. Lancet 2005; 366: 1607-21"   Back to cited text no. 3      
4."Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomized trial in acute myocardial infarction. The Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 Investigators. THE LANCET Vol 358:605-613 August 25, 2001"   Back to cited text no. 4      


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  In this article
    Initial Recognit...
    Brief Physical E...
    Differential Dia...
    Assessment of Re...
    Pharmacological ...
    Laboratory Evalu...
    Biochemical Markers
    Acute CCU Management
    Emergency Manage...
    Characteristics ...
    Secondary Preven...
    Drugs Commonly U...

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