2012 Guidelines of the Taiwan Society of Cardiology (TSOC) for the management of ST-segment elevation myocardial infarction

ST-segment elevation myocardial infarction (STEMI) is one of the most common cardiovascular diseases in Taiwan. The management strategies for STEMI are to do early diagnosis, minimize delay of medical contact, and administration of reperfusion therapy as rapidly as possible. Initial evaluation in emergency department for STEMI includes concise history taking, physical examination, electrocardiogram and cardiac biomarkers measurement. A 12-lead electrocardiogram should be performed within 10 minutes of emergency department arrival. Oxygen, nitroglycerin, analgesia, dual antiplatelet therapy and anticoagulation drugs should be given immediately. Patients with STEMI should receive reperfusion therapy either by primary percutaneous coronary intervention with door-to-balloon time within 90 minutes or by thrombolytic therapy with door-to-needle time within 30 minutes. The pharmacological treatment after admission includes antiplatelet drugs, anticoagulation drugs, beta blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers and statins. STEMI patients should be watched out for hypotension, heart failure or even cardiogenic shock. Mechanical complications, such as acute mitral regurgitation, septum rupture and free wall rupture, cause high mortality after STEMI. Tachy- and bradyarrhythmias are also common in patients with STEMI and should be treated accordingly. Permanent cardiac pacing and implantable cardioverter defibrillator may be necessary after STEMI. Coronary artery bypass grafting surgery may be performed as a definitive or adjunctive revascularization therapy after STEMI. Surgery is also necessary if there are mechanical complications. Before discharge, cardiac rehabilitation should be considered when patients are stabilized. Referral for outpatient rehabilitation should also be encouraged. Antiplatelet drugs, beta blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers and statins should be continued after discharge for secondary prevention. Effective hypertension, diabetes and lipid control are important after STEMI.