ASEAN Heart Journal

Intended for healthcare professional

Original Paper

ASEAN Heart Journal

July 2014, 22:14

First online: 07 August 2014

Original Paper

Malaysia CPG for STEMI

Robaayah Zambahari,1 Jeyamalar Rajadurai,2 Alan Fong,3 Aris Chandran,4 Choo Gim Hooi,2 Nurul Aida Salleh,5 Omar Ismail,6 Oteh Maskon,7 Rahal Yusoff,8 Rosli Mohd Ali,1 Wan Azman Wan Ahmad9
Open Access
This content is freely available to anyone, anywhere at any time.
  • Summary
  • Supplementary Material
  • References
  • About this Article

Summary

  • The diagnosis of STEMI depends on the presence of ischaemic type chest pain and ST elevation in the resting ECG or new onset LBBB. It should be supported by a rise and fall in cardiac biomarkers.
  • TIME LOST IS MYOCARDIUM LOST, thus early diagnosis and treatment is important.
  • Early management of STEMI involves pain relief, stabilisation of haemodynamics and assessment for reperfusion.
  • The occluded infarct-related artery should be opened as soon as possible. The appropriate and timely use of some form of reperfusion therapy is more important than the choice of therapy.( Flowchart 1)
  • Primary PCI is the reperfusion strategy of choice if it can be done in a timely manner by an experienced operator. The DBT should be <90 mins or < 120 mins if transferred from a non PCI capable hospital.
  • If primary PCI cannot be performed, then fibrinolytic therapy should be administered with a DNT of less than 30 minutes. The role of PCI in the management of patients with STEMI is as listed in Table 1.
  • Concomitant pharmacotherapy includes aspirin, clopidogrel (prasugrel or ticagrelor), β-blockers, ACEIs/ ARBs and statins. (Table 2)
  • Complications of STEMI include arrhythmias, LV dysfunction and shock.
  • High-risk patients who have received fibrinolysis, should have early coronary angiography with view to revascularisation. The others should be risk stratified according to the presence or absence of ischaemia, arrhythmias and LV function.
  • Secondary prevention is important and includes the use of aspirin, β-blockers, ACE-Is/ARBs and statins. (Table 3)
  • All patients should be encouraged to undergo cardiac rehabilitation.

Keywords

Cardiac Rehabilitation - Prasugrel - Ticagrelor - STEMI Patient - Reperfusion Strategy


Open Access: This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

Supplementary Material

Nil

References

 

About this Article

Title
Malaysia CPG for STEMI


Open Access
Available under Open Access


Journal >> 22:1


Online Date
21 November 2019


DOI
10.7603/s40602-014-0013-1


Online ISSN
2315-4551


Publisher
ASEAN Federation of Cardiology


Additional Links Cardiology


Keywords
Cardiac Rehabilitation
Prasugrel
Ticagrelor
STEMI Patient
Reperfusion Strategy


Author Affiliations
1. National Heart Institute Kuala Lumpur, Kuala Lumpur, Malaysia
2. Subang Jaya Medical Centre, Selangor, Malaysian
3. Sarawak General Hospital Heart Centre, Sarawak, Malaysian
4. Hospital Raja Permaisuri Bainun, Ipoh, Malaysian
5. Primary Health Clinic Tanglin, Kuala Lumpur, Malaysian
6. Hospital Pulau Pinang, Penang, Malaysian
7. Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysian
8. Hospital Kuala Lumpur, Lumpur, Malaysian
9. University Malaya Medical Centre Kuala Lumpur, Kuala Lumpur, Malaysian


Correspondence to:
Robaayah Zambahari,[email protected]
Open Access
This content is freely available to anyone, anywhere at any time.