Malaysia CPG for STEMI

• 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.

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