Management of ST-elevation myocardial

infarction according to European and American

guidelines

comparison of guidlines ESC 2012 and ACCF/AHAterms of class of recommendation level of evidence

main common recommendations

PCI-capable centre with symptom duration <12 h => <90 min

non-PCI centre<120 min

culprit lesion (except cardiogenic shock)

radial approach ; thrombus aspiration; DES implantation

prasugrel or ticagrelor preferred over clopidogrel

During PCI bivalirudin and unfractioned heparin indicated <-> fondaparinux contraindicated

dual antiplatelet therapy 12 monthsBMS 1 monthDES 6 months

fibrinolysisPCI not possible large infarctPCI in >90

coronary angiography within 3-24 h

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

Differences