Statistics indicate that in 2001 there were ~1.7 million hospital discharges for acute coronary syndromes (ACS). According to the National Registry of Myocardial Infarction 4, it is estimated that ~30% of the ACS patients have ST-elevation myocardial infarction (STEMI). This percentage translates to ~500,000 STEMI events per year in the United States.1,2
Recently, the American Heart Association (AHA), in partnership with the American College of Cardiology (ACC), published a new set of guidelines for the management of patients with STEMI.3 The focus of this article is on medications used in the management of STEMI patients.
For ease of comparison, a Table is provided that reviews and compares only the changes between the old (1999) and the new (2004) guidelines. Readers are encouraged to refer to the actual guidelines for a comprehensive review of each section.
Recommendation Classifications and Levels of Evidence
The customary ACC/AHA classifications (I, 7 IIa, IIb, and III) and levels of evidence (A, B, and C) are used in these guidelines:
- Class I: Conditions for which there is evidence or general agreement that a given procedure or treatment is useful and effective
- Class II: Conditions for which there is conflicting evidence or a divergence of opinion about the usefulness/efficacy of a procedure or treatment
- Class IIa: Weight of evidence/opinion in favor of usefulness/ efficacy
- Class IIb: Usefulness/efficacy less well established by evidence/opinion
- Class III: Conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful
- Level of Evidence A: Data derived from multiple population risk strata
- Level of Evidence B: Data derived from limited population risk strata
- Level of Evidence C: Data derived from very limited risk strata
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Dr. Ng is an instructor of pharmacy practice and a cardiology pharmacy practice resident, Midwestern University, College of Pharmacy-Glendale. Dr. Nguyen is a pharmacist with Banner Thunderbird Medical Center. Dr. Tafreshi is an associate professor of pharmacy and medicine and director of the cardiology pharmacy practice residency, Midwestern University, College of Pharmacy-Glendale.