In cardiogenic shock, non–infarct-related artery PCI should be considered during the index procedure. In some cases, there is a gap between optimal guideline-based treatment and actual care of STEMI patients. What is new in the 2017 version? 4.3 Cardiac arrest 10 11. 2. var link = $(this).attr("href"); Non-ST-segment elevation myocardial infarction (NSTEMI) is a global he… The following are key points to remember about the 2017 European Society of Cardiology (ESC) Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation: Clinical Topics: Acute Coronary Syndromes, Anticoagulation Management, Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Anticoagulation Management and ACS, EP Basic Science, Acute Heart Failure, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging, Keywords: Acute Coronary Syndrome, Anticoagulants, Bundle-Branch Block, Constriction, Pathologic, Coronary Angiography, Coronary Occlusion, Coronary Stenosis, Diagnostic Tests, Routine, Drug-Eluting Stents, Electrocardiography, Fibrinolysis, Fibrinolytic Agents, Hospital Mortality, Myocardial Infarction, Percutaneous Coronary Intervention, Renal Insufficiency, Reperfusion, Shock, Cardiogenic, Standard of Care, Thrombosis. The in-hospital mortality rates of unselected patients with STEMI in national European registries vary between 4–12%. Special attention should be paid to dose adjustment of some pharmacological strategies in these subsets. Authors: Ibanez B, James S, Agewall S, et al. Evidenced-based 'To do and not to do' messages from the Guidelines    14. _gaq.push(['is._trackEvent', 'Download', 'Click', text]); Emergency care 8 8. Gaps in the evidence and areas for future research    12. In order to bring you the best possible user experience, this site uses Javascript. A sizeable proportion of STEMI patients do not present significant coronary artery stenosis on urgent angiography. ESC Clinical Practice Guidelines and scientific statements are prepared by task forces which are groups of cardiologists that meet upon request to deal with particular problems in cardiology. 3. STEMI patients should undergo a primary PCI strategy unless the anticipated absolute time from STEMI diagnosis to PCI-mediated reperfusion is >120 minutes, when fibrinolysis should be initiated immediately (i.e., within 10 minutes of STEMI diagnosis). 'content-date':'2017-08-26', 4.4 Pre-hospital logistics of care 10 12. It ranges from cardiac arrest, electrical or haemodynamic instability with cardiogenic shock (CS) due to ongoing ischaemia or mechanical complications such as severe mitral regurgitation, to patients who are already pain free again at the time of presentation. ga.src = ('https:' == document.location.protocol ? Read your latest personalised notifications. Introduction 6 4. }); 7 7. Non-ST Elevation Acute Coronary Syndromes. 'canonicalURL':'https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-Myocardial-Infarction-in-patients-presenting-with-ST-segment-elevation-Ma', _gaq.push(['is._trackPageview']); _gaq.push(['is._setAccount', 'UA-33838783-11']); Reference European Heart Journal, doi/10.1093/eurheartj/ehv320, Reference Web Addenda - doi:10.1093/eurheartj/ehv320, Reference Q&A antithrombotic treatment NSTE-ACS GL - doi:10.1093/eurheartj/ehv407, Reference Q&A myocardial revascularization NSTE-ACS GL - doi:10.1093/eurheartj/ehv408, Reference Q&A diagnosis and risk assessment NSTE-ACS GL - doi:10.1093/eurheartj/ehv409, Reference European Heart Journal (2011) 32, 2999–3054, Association for Acute CardioVascular Care, European Association of Preventive Cardiology, European Association of Cardiovascular Imaging, European Association of Percutaneous Cardiovascular Interventions, Association of Cardiovascular Nursing & Allied Professions, Working Group on Atherosclerosis and Vascular Biology, Working Group on Cardiac Cellular Electrophysiology, Working Group on Pulmonary Circulation & Right Ventricular Function, Working Group on Aorta and Peripheral Vascular Diseases, Working Group on Myocardial & Pericardial Diseases, Working Group on Adult Congenital Heart Disease, Working Group on Development, Anatomy & Pathology, Working Group on Coronary Pathophysiology & Microcirculation, Working Group on Cellular Biology of the Heart, Working Group on Cardiovascular Pharmacotherapy, Working Group on Cardiovascular Regenerative and Reparative Medicine, Guidelines and National Cardiac Societies, Universal definition of myocardial infarction, Unstable angina in the era of high-sensitivity cardiac troponin assays, Number and breakdown of classes of recommendations (Supplementary data), Clinical presentation (Supplementary data), Physical examination (Supplementary data), Biomarkers: high-sensitivity cardiac troponin, Rapid ‘rule-in’ and ‘rule-out’ algorithms, Electrocardiogram indicators (Supplementary data), Clinical scores for risk assessment (Supplementary data), Peri-interventional anticoagulant treatment, Peri-interventional antiplatelet treatment, Post-interventional and maintenance treatment, Pharmacological treatment of ischaemia (Supplementary data), Supportive pharmacological treatment (Supplementary data), Nitrates and beta-blockers (Supplementary data), Managing oral antiplatelet agents in patients requiring long-term oral anticoagulants, Patients with atrial fibrillation without mechanical prosthetic heart valves or moderate-to-severe mitral stenosis undergoing percutaneous coronary intervention or managed (Supplementary data), Patients requiring vitamin K antagonists or undergoing coronary artery bypass surgery, Management of acute bleeding events (Supplementary data), General supportive measures (Supplementary data), Bleeding events on antiplatelet agents (Supplementary data), Bleeding events on vitamin K antagonists (Supplementary data), Bleeding events on non-vitamin K antagonist oral anticoagulants (Supplementary data), Non-access-related bleeding events (Supplementary data), Bleeding events related to percutaneous coronary intervention (Supplementary data), Bleeding events related to coronary artery bypass surgery (Supplementary data) 68, Recommendations for bleeding management and blood transfusion in non-ST-segment elevation acute coronary syndromes for anticoagulated patients, Invasive coronary angiography and revascularization, Routine invasive vs. selective invasive approach (Supplementary data), Pattern of coronary artery disease in non-ST-segment elevation acute coronary syndrome (Supplementary data), How to identify the culprit lesion?

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