Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS). ST-Elevation Myocardial Infarction (STEMI) Algorithm.

[See AMI Complications algorithm]

Download a printable copy in PDF format.

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); 2008 October. 69 p. Diagnosis and Treatment of Chest Pain and Acute Coronary Syndrome (ACS) ST-Elevation Myocardial Infarction (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 electrocardiogram. 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? Critical care unit admission. A PCI or CABG? Facilities without PCI capabilities should activate their established 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 Phase 2 cardiac rehabilitation - if available. A Chronic adjunctive medications/outpatient managment. A A = Annotation Phase 3/phase 4 cardiac rehabilitation if appropriate. A Periodic lifestyle and risk factor reassessment All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.