New Guidelines for the Management of Patients with MI

Statistics indicate that in 2001 there were ~1.7 millionhospital discharges for acute coronary syndromes(ACS). According to the National Registry ofMyocardial Infarction 4, it is estimated that ~30% of theACS patients have ST-elevation myocardial infarction(STEMI). This percentage translates to ~500,000 STEMIevents per year in the United States.^1,2

New Guidelines

Recently, the American Heart Association (AHA), in partnershipwith the American College of Cardiology (ACC),published a new set of guidelines for the management ofpatients with STEMI.³ The focus of this article is on medicationsused in the management of STEMI patients.

For ease of comparison, a Table is provided that reviewsand compares only the changes between the old (1999) andthe new (2004) guidelines. Readers are encouraged to referto the actual guidelines for a comprehensive review of eachsection.

Recommendation Classifications and Levels ofEvidence

The customary ACC/AHA classifications (I, ⁷ IIa, IIb, andIII) and levels of evidence (A, B, and C) are used in theseguidelines:

• Class I: Conditions for which there is evidence or generalagreement that a given procedure or treatment is usefuland effective
• Class II: Conditions for which there is conflicting evidenceor a divergence of opinion about the usefulness/efficacyof a procedure or treatment
• Class IIa: Weight of evidence/opinion in favor of usefulness/efficacy
• Class IIb: Usefulness/efficacy less well established byevidence/opinion
• Class III: Conditions for which there is evidenceand/or general agreement that the procedure/treatment isnot useful/effective and in some cases may be harmful
• Level of Evidence A: Data derived from multiple populationrisk strata
• Level of Evidence B: Data derived from limited populationrisk strata
• Level of Evidence C: Data derived from very limitedrisk strata

For a list of references, send a stamped, self-addressed envelope to:References Department, Attn. A. Stahl, Pharmacy Times,241 Forsgate Drive, Jamesburg, NJ 08831;or send an e-mail request to: astahl@mwc.com.

Dr. Ng is an instructor of pharmacy practice and a cardiologypharmacy practice resident, Midwestern University, College ofPharmacy-Glendale. Dr. Nguyen is a pharmacist with BannerThunderbird Medical Center. Dr. Tafreshi is an associate professorof pharmacy and medicine and director of the cardiologypharmacy practice residency, Midwestern University,College of Pharmacy-Glendale.