STEMI

STEMI

1. MONA

2. Beta Blocker

3. Primary PCI

   • Abciximab ASAP before PCI
     • Alternative GP IIb/IIIa inhibitor

4. Thrombolytic

   • Tissue Plasminogen Activators
     • Non-selective (not used)
       • Streptokinase
       • Anistreplase
       • Urokinase
     • Selective
       • Alteplase
       • Reteplase
       • Tenecteplase
   • Anticoagulation with thrombolysis for >48 h
     • d/c after PCI or CABG
     • UFH 60 units/kg bolus then 12 units/kg/h
       • Monitor aPTT and H/H
     • IF <75 enoxaparin 30 mg IV bolus then 1 mg/kg SQ q12
       • If >75 no bolus and 0.75 mg/kg SQ BID
       • CrCl <30 ml/min use 1 mg/kg SQ q24h
         • Contraindicated in dialysis pts.
     • Fondaparinux 2.5 mg IV bolus then 2.5 mg SQ q24h
       • Monitor H/H and SCr
       • Contraindicated in CrCl <30 ml/min

5. If stented, add clopidogrel

   • 300 mg load if <75
   • Withhold >5 days pre-CABG

6. Prasugrel

   • NOT studied with medical management (thrombolytic monotherapy)

7. Ticagrelor

   • 180 mg load then 90 mg BID

8. Aldosterone Antagonists

9. Statin

10. ACEi

    • Start after SL nitroglycerin, beta blocker
    • Lifelong if LV dysfunction, HF, anterior MI
    • Caution hypotenstion and chronic renal failure
    • Contraindicated in acute renal failure
    • Oral only, no IV