New ST-elevation Myocardial Infarction Guidelines Emphasize Speed and Aggressive Treatment and Lower Low-density Lipoprotein Cholesterol Levels

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Citation
US Cardiology 2004;2004:1(1)

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In July 2004, the American College of Cardiology (ACC) and the American Heart Association (AHA) Joint Task Force on Practice Guidelines released new practice guidelines for ST-elevation myocardial infarction (STEMI), which emphasize the need for speed when chest pain or other symptoms of a heart attack strike. Speedy treatment not only means the difference between life and death but also between disability and a return to an active lifestyle. Treating STEMI requires fast action because, if blood flow is not restored to the heart within 20 minutes, serious damage or death occurs.

The guidelines are organized to make it easier for physicians and other medical personnel to quickly identify the information they need to provide the best treatment.The content outline follows the chronological flow of a patientÔÇÖs interface with physicians and other healthcare workers, providing clear treatment instructions for acute STEMI stages, possible percutaneous coronary intervention (PCI) or more, and hospitalization if necessary. In addition, specific guidelines about medical treatments pre- and post-STEMI, and aggressive recommendations for secondary treatment and long-term management are provided. Of particular note are the recommendations regarding more aggressive cholesterol-lowering therapy recommendations that are reinforced by the recently released update of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) guidelines.1

The ACC and AHA have jointly engaged in the production of practice guidelines in the area of cardiovascular disease since 1980. This effort is directed by the ACC/AHA Task Force on Practice Guidelines, whose charge is to develop and revise practice guidelines for important cardiovascular diseases and procedures.

The first practice guideline, written in 1990 under the auspices of the ACC/AHA Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures, was Guidelines for the Early Management of Patients with Acute Myocardial Infarction.2 Over the years, as information grew, the purpose and text of the guidelines evolved.After 1990, the next effort came from the ACC/AHA Task Force on Practice Guidelines, which began work in 1994 and produced ACC/AHA Guidelines for the Management of Patients with Acute Myocardial Infarction,3 using the term 'acute coronary syndromeÔÇÖ to reflect the emerging overarching concept that disruption of a vulnerable or high-risk plaque causes an episode of ischemic discomfort.

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References
  1. Grundy M, et al., "Implications of recent clinical trials for the national cholesterol education program: the national cholesterol education program adult treatment panel III update", Approved by the National Heart, Lung, and Blood Institute, April 2004. Available on www.acc.org and J.Am. Coll. Cardiol. (August 2004),
  2. Gunnar R M, Bourdillon P D V, Dixon D W, et al., "Guidelines for the early management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures", J.Am. Coll. Cardiol. (1990), 16: pp. 249-252.
    Crossref | PubMed
  3. Ryan et al.,"ACC/AHA Guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines", J. Am. Coll. Cardiol. (1996), 28: pp.328-428.Available on www.acc.org
    PubMed
  4. Braunwald et al.,"Management of patients with unstable angina and non-st-segment elevation myocardial infarction: 2000 update: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines", J. Am. Coll. Cardiol. (2000), 36: pp. 970-1,056.Available at www.acc.org