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2004 ACC/AHA guideline for the management of patients with STEMI: the implications for clinicians

Nature Clinical Practice Cardiovascular Medicine volume 2, pages 114–115 (2005)Cite this article

In 1990, the American College of Cardiology (ACC) and American Heart Association (AHA) produced their first guideline for the management of patients with acute myocardial infarction (MI). This guideline has been updated, revised and was extensively refocused and expanded in 2004.1 Even though the 2004 guideline focuses only on patients with ST-segment elevation MI (STEMI)—previous guidelines also addressed patients with non-STEMI—it is much more detailed than earlier versions. It has become the ultimate reference for management of STEMI. The purpose of this viewpoint is to highlight the significant changes between the 1999 and 2004 versions that will most affect clinicians.

Health-care providers who treat patients with STEMI should be aware of the four major areas of revision: preference for primary percutaneous coronary intervention (PCI) over fibrinolytics in a wider range of patients; more-aggressive treatment of cardiogenic shock; increased emphasis on risk stratification at multiple time points, including at presentation and before hospital discharge; and greater clarity regarding adjunctive antiplatelet therapy, anticoagulants, inhibitors of the renin–angiotensin–aldosterone system (RAAS) and lipid-lowering agents.

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Author information

Authors and Affiliations

  1. TIMI Study Group,

    Robert P Giugliano & Eugene Braunwald

  2. Brigham and Women's Hospital, Boston, MA, USA

    Robert P Giugliano & Eugene Braunwald

Authors
  1. Robert P Giugliano
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  2. Eugene Braunwald
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Corresponding author

Correspondence to Robert P Giugliano.

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Competing interests

E Braunwald has received research grants from Bristol Myers Squibb, Aventis, Eli Lilly, Millennium, Ihotek,Inotek Pharmaceuticals, CV Therapeutics and AstraZeneca. RP Giugliano has received research grants from Millennium and Schering Plough. He has also received honoraria for speaking from Millennium, Schering Plough, Aventis, Bristol Myers Squibb, Sanofi and Pfizer.

Supplementary information

Supplementary Figure 1

Guide for whether patients with STEMI should be treated with primary PCI or fibrinolytic therapy. STEMI, ST-Elevation Myocardial Infarction; PCI, percutaneous coronary intervention; ICH, intracerebral hemorrhage.

Supplementary Table 1

Assessment of reperfusion options in patients with STEMI. STEMI, ST-Elevation Myocardial Infarction.

Glossary

SHOCK

SHould we emergently revascularize Occluded Coronaries for cardiogenic shocK?

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Giugliano, R., Braunwald, E. 2004 ACC/AHA guideline for the management of patients with STEMI: the implications for clinicians. Nat Rev Cardiol 2, 114–115 (2005). https://doi.org/10.1038/ncpcardio0135

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