Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS). STEMI Algorithm.

[See AMI Complications algorithm]

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Source: Institute for Clinical Systems Improvement (ICSI). Diagnosis and treatment of chest pain and acute coronary syndrome (ACS). Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Oct. 76 p. Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS) STEMI Algorithm *PCI refers to percutaneous coronary intervention which includes percutaneous transluminal coronary angioplasty (PTCA) as well as other percutaneous interventions. ST-segment elevation on ECG. A Thrombolysis should be instituted within 30-60 minutes of arrival. Primary PCI* should be performed within 90 minutes of arrival, with a target of less than 60 minutes. Thrombolytics or PCI* for initial therapy. A Emergency coronary angiography and primary PCI*. A Failed thrombolytics? CCU admission. A PCI or CABG? Facilities without PCI capabilities should consider establishing processes and criteria for transfer for immediate PCI. CCU care *Chronic adjunctive medications. *Phase I cardiac rehabilitation. A Out of guideline Complications? A See AMI Complications algorithm Transfer to post-CCU care. A Complications? Risk stratification. A Cardiac catheterization. A Patient at increased risk and needs intervention? A PCI*, CABG, or other revascularization procedure Revascularization candidate? A Secondary prevention and risk factor modification. A Out of guideline Continue adjunctive medications. A Discharge. A ECG-monitored exercise needed? A Phase 2 cardiac rehabilitation - outpatient. A Phase 3 cardiac rehabilitation. A A = Annotation Short-term follow-up: chronic adjunctive medications/outpatient management. A All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.