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The American Heart Association (AHA) and the American College of Cardiology (ACC) have recently released updated recommendations for patients presenting with ST-elevation myocardial Infarction. The need for fast action is the primary message of these revised recommendations since permanent heart damage is known to occur if blood flow is not restored within twenty minutes of the onset of symptoms.


The new guidelines provide four specific decision making criteria to determine if thrombolytics or stents should be used with patients presenting with STEMI: 1) the time that has passed since the onset of symptoms; 2) the risk of death; 3) the risk of intracranial hemorrhage with thrombolytic use and; 3) how much time is needed to get the patient to a cardiac catheterization lab for stent insertion.


The guidelines also recommend the daily use of aspirin and beta blockers. ACE inhibitors are strongly recommended. If intolerance to ACE inhibitors is a concern, angiotensin receptor blockers are recommended.


Statin drugs are advised on discharge for those with low-density lipoprotein levels (LDL) greater than or equal to 100mg/dl. Sidney Smith, Co-Chair of the Task Force noted that this guideline is more aggressive than the original "Adult treatment III goal recommended by the National Cholesterol Education Panel". Smith continues to note that aggressively lowering the LDL improves the patient outcomes in large clinical trials of statin drugs.


Nurses inemergency rooms or in other immediate care facilities need to be aware of these guidelines. Providing the correct assessment data can make a critical difference in time of treatment, appropriateness of treatment, the extent of myocardial damage, and even survival. Full guidelines are available at


Source:American Heart Association. March 26, 2009. Emergency Medicine Cardiac Research and Education Group (EMCERG). Available at Accessed March 26, 2009.