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Management of ST-elevation myocardial
infarction according to European and American
guidelines
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comparison of guidlines ESC 2012 and ACCF/AHAterms of class of recommendation level of evidence
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main common recommendations
PCI-capable centre with symptom duration <12 h => <90 min
non-PCI centre<120 min
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culprit lesion (except cardiogenic shock)
radial approach ; thrombus aspiration; DES implantation
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prasugrel or ticagrelor preferred over clopidogrel
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During PCI bivalirudin and unfractioned heparin indicated <-> fondaparinux contraindicated
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dual antiplatelet therapy 12 monthsBMS 1 monthDES 6 months
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fibrinolysisPCI not possible large infarctPCI in >90
coronary angiography within 3-24 h
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post-discharge optimising coronary risk factor control smoke cessation rehabilitation programmes
medication DAPT 12 month beta-blockers ACE /ARB inhibitors statins: LDL < 70 mg/dl aldosterone inhibitors : left ventricular dysfunction Anticoagulation: left ventricular disfunction, atrial
fibrillation
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Differences
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