ST-segment myocardial infarction (STEMI) is a time-sensitive emergency that requires swift and seamless integration of prehospital and emergency department resources in order to achieve early diagnosis and reperfusion therapy. This issue reviews the current literature on emergency department management of STEMI, including recognition of more subtle diagnoses on electrocardiogram, identification of STEMI mimics, an update on treatment therapies, and strategies to achieve more effective management of STEMI across gender and age groups.
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Following are the most informative references cited in this paper, as determined by the authors.
1. Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J. 2019;40(3):237-269. (Guideline) DOI: 10.1093/eurheartj/ehy462
4. O’Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-e425. (Evidence-based guideline) DOI: 10.1161/CIR.0b013e3182742c84
8. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non–ST-elevation myocardial infarction. Circulation. 2007;116(7). (Guideline) DOI: 10.1161/CIRCULATIONAHA.107.181940
35. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2):119-177. (Evidence-based guideline) DOI: 10.1093/eurheartj/ehx393
40. Tabas JA, Rodriguez RM, Seligman HK, et al. Electrocardiographic criteria for detecting acute myocardial infarction in patients with left bundle branch block: a meta-analysis. Ann Emerg Med. 2008;52(4):329-336. (Systematic review and meta-analysis; 11 studies, 2100 patients) DOI: 10.1016/j.annemergmed.2007.12.006
57. American College of Emergency Physicians Clinical Policies Subcommittee on Reperfusion Therapy for Acute STEMI, Promes SB, Glauser JM, et al. Clinical Policy: emergency department management of patients needing reperfusion therapy for acute ST-segment elevation myocardial infarction. Ann Emerg Med. 2017;70(5):724-739. (Clinical Policy) DOI: 10.1016/j.annemergmed.2017.09.035
76. Wenger N. “STEMI at Elderly Age: Expert Analysis.“ 2016. Accessed December 10, 2020. (ACC expert anaylsis)
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Keywords: STEMI, myocardial infarction, acute coronary syndromes, ACS, electrocardiogram, ECG, EMS, diaphoresis, troponin, left bundle branch block, LBBB, posterior, Inferobasal, Sgarbossa, PCI, reciprocal, oxygen, aspirin, opioids, P2Y12, nitroglycerin, thrombolytic, fibrinogen, heparin, cocaine
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Marshall Frank, DO, MPH, FACEP; Carson Sanders, BS, NRP, CCEMT-P; Bryan P. Berry, MD, BCEM, FACEP
James Morris, MD, MPH; Douglas L. Robinson, DO, MS; Andrew Schmidt, DO, MPH
January 1, 2021
January 1, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.
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