Emergency Department Management of Patients Needing Reperfusion Therapy for Acute ST-Segment Elevation Myocardial Infarction

Official 2017 guideline from the American College of Emergency Physicians.

Strength

Recommendations

Fibrinolytics for Delayed PCI

Level B

Fibrinolytics may be administered to patients when door-to-balloon (D2B) time is anticipated to exceed 120 minutes.

Level C

A dose reduction should be considered when administering fibrinolytics to patients aged 75 years or older.

Transfer to PCI Center

Level B

To decrease the incidence of major adverse cardiac events (MACE), patients with ST-segment elevation myocardial infarction (STEMI) should be transferred to a percutaneous coronary intervention (PCI)-capable hospital as soon as possible.

Opioid Use

Level C

Because safety has not been established, clinical judgment should be used in deciding whether to provide or withhold morphine in patients undergoing reperfusion therapy.

Literature

Original/Primary Reference

Promes SB, Glauser JM, Smith MD, et al. American College of Emergency Physicians. Clinical Policy: Emergency Department Management of Patients Needing Reperfusion Therapy for Acute ST-Segment Elevation Myocardial Infarction. Ann Emerg Med. 2017;70(5):724-

Summary By

Eric Steinberg, DO, MEHP

What do the ratings mean?

Level A

Generally accepted principles for patient care that reflect a high degree of clinical certainty (eg, based on evidence from one or more Class of Evidence I or multiple Class of Evidence II studies).

Level B

Recommendations for patient care that may identify a particular strategy or range of strategies that reflect moderate clinical certainty (eg, based on evidence from one or more Class of Evidence II studies or strong consensus of Class of Evidence III studies).

Level C

Recommendations for patient care that are based on evidence from Class of Evidence III studies or, in the absence of any adequate published literature, based on expert consensus. In instances in which consensus recommendations are made, “consensus” is placed in parentheses at the end of the recommendation.