ACCFAHA Guideline for the Management of ST Elevation Myocardial Infarction.Table of Contents.Preamble e. 36. 41.Introduction e. 36.Methodology and Evidence Review e.Organization of the Writing Committee e.Document Review and Approval e.Background e. 36.Definition and Diagnosis e.Epidemiology e. 36.Early Risk Assessment e.Onset of MI e. 36.Patient Related Delays and Initial Treatment e.Mode of Transport to the Hospital e.Patient Education e.Community Preparedness and System Goals for Reperfusion Therapy e.Regional Systems of STEMI Care, Reperfusion Therapy, and Time to Treatment Goals Recommendations e.Regional Systems of STEMI Care and Goals for Reperfusion Therapy e.Strategies for Shortening Door to Device Times e.Prehospital Fibrinolytic Therapy e.Advanced Windows Mail Recovery V3 0 Full Tested Positive For Group' title='Advanced Windows Mail Recovery V3 0 Full Tested Positive For Group' />The Relationship Between Sudden Cardiac Death and STEMI e.Evaluation and Management of Patients With STEMI and Out of Hospital Cardiac Arrest Recommendations e.Reperfusion at a PCI Capable Hospital e.Primary PCI e. 37.Primary PCI in STEMI Recommendations e.Aspiration Thrombectomy Recommendation e.Use of Stents in Primary PCI e.Use of Stents in Patients With STEMI Recommendations e.Adjunctive Antithrombotic Therapy for Primary PCI e.Antiplatelet Therapy to Support Primary PCI for STEMI Recommendations e.Anticoagulant Therapy to Support Primary PCI Recommendations e.Reperfusion at a NonPCI Capable Hospital e.Fibrinolytic Therapy When There Is an Anticipated Delay to Performing Primary PCI Within 1.Minutes of FMC Recommendations e.Timing of Fibrinolytic Therapy e.Choice of Fibrinolytic Agent e.Contraindications and Complications With Fibrinolytic Therapy e. 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Adjunctive Antithrombotic Therapy With Fibrinolysis e.Adjunctive Antiplatelet Therapy With Fibrinolysis Recommendations e.Adjunctive Anticoagulant Therapy With Fibrinolysis Recommendations e.Assessment of Reperfusion After Fibrinolysis e.Transfer to a PCI Capable Hospital After Fibrinolytic Therapy e.Transfer of Patients With STEMI to a PCI Capable Hospital for Coronary Angiography After Fibrinolytic Therapy Recommendations e.Transfer for Cardiogenic Shock e.Transfer for Failure of Fibrinolytic Therapy e.Transfer for Routine Early Coronary Angiography After Fibrinolytic Therapy e.Delayed Invasive Management e.Coronary Angiography in Patients Who Initially Were Managed With Fibrinolytic Therapy or Who Did Not Receive Reperfusion Recommendations e.PCI of an Infarct Artery in Patients Initially Managed With Fibrinolysis or Who Did Not Receive Reperfusion Therapy Recommendations e.PCI of a Noninfarct Artery Before Hospital Discharge Recommendations e.Adjunctive Antithrombotic Therapy to Support Delayed PCI After Fibrinolytic Therapy e.Antiplatelet Therapy to Support PCI After Fibrinolytic Therapy Recommendations e.Anticoagulant Therapy to Support PCI After Fibrinolytic Therapy Recommendations e.Coronary Artery Bypass Graft Surgery e.CABG in Patients With STEMI Recommendations e.Timing of Urgent CABG in Patients With STEMI in Relation to Use of Antiplatelet Agents Recommendations e.Routine Medical Therapies e.Beta Blockers Recommendations e.Renin Angiotensin Aldosterone System Inhibitors Recommendations e.Recommendations for Lipid Management e.Nitrates e. 39. 18.Calcium Channel Blockers e.Oxygen e. 39. 18.Analgesics Morphine, Nonsteroidal Anti inflammatory Drugs, and Cyclooxygenase II Inhibitors e.Complications After STEMI e.Cardiogenic Shock e.Treatment of Cardiogenic Shock Recommendations e.Severe HF e. 39. 29.RV Infarction e. 39.Advanced Windows Mail Recovery V3 0 Full Tested Positive For Group' title='Advanced Windows Mail Recovery V3 0 Full Tested Positive For Group' />Mechanical Complications e.Diagnosis e. 39. 29.Mitral Regurgitation e.Ventricular Septal Rupture e.LV Free Wall Rupture e.LV Aneurysm e. 39.Electrical Complications During the Hospital Phase of STEMI e.Ventricular Arrhythmias e.Advanced Windows Mail Recovery V3 0 Full Tested Positive For Group' title='Advanced Windows Mail Recovery V3 0 Full Tested Positive For Group' />UpdateStar is compatible with Windows platforms.UpdateStar has been tested to meet all of the technical requirements to be compatible with Windows 10, 8.Windows 8. Network Attached Storage NAS for home and business, Synology is dedicated to provide DiskStation NAS that offers RAID storage, storage for virtualization, backup.Implantable Cardioverter Defibrillator Therapy Before Discharge e.AF and Other Supraventricular Tachyarrhythmias e.Bradycardia, AV Block, and Intraventricular Conduction Defects e.Pacing in STEMI Recommendation e.Pericarditis e. 39.Management of Pericarditis After STEMI Recommendations e.Thromboembolic and Bleeding Complications e.Thromboembolic Complications e.Anticoagulation Recommendations e.Heparin Induced Thrombocytopenia e.Bleeding Complications e.Treatment of ICH e.Vascular Access Site Bleeding e.Acute Kidney Injury e.Hyperglycemia e. 39.Risk Assessment After STEMI e.Use of Noninvasive Testing for Ischemia Before Discharge Recommendations e.Assessment of LV Function Recommendation e.Assessment of Risk for SCD Recommendation e.Posthospitalization Plan of Care e.Posthospitalization Plan of Care Recommendations e.The Plan of Care for Patients With STEMI e.Smoking Cessation e.Cardiac Rehabilitation e.Systems of Care to Promote Care Coordination e.Unresolved Issues and Future Research Directions e.Patient Awareness e.Regional Systems of Care e.Transfer and Management of NonHigh Risk Patients After Administration of Fibrinolytic Therapy e.Antithrombotic Therapy e.Reperfusion Injury e.Approach to Noninfarct Artery Disease e.Prevention of SCD e.Prevention of HF e.References e. 40.Appendix 1. Author Relationships With Industry and Other Entities Relevant e.Appendix 2. Reviewer Relationships With Industry and Other Entities Relevant e.Appendix 3. Abbreviation List e.Preamble. The medical profession should play a central role in evaluating the evidence related to drugs, devices, and procedures for the detection, management, and prevention of disease.When properly applied, expert analysis of available data on the benefits and risks of these therapies and procedures can improve the quality of care, optimize patient outcomes, and favorably affect costs by focusing resources on the most effective strategies.An organized and directed approach to a thorough review of evidence has resulted in the production of clinical practice guidelines that assist physicians in selecting the best management strategy for an individual patient.Moreover, clinical practice guidelines can provide a foundation for other applications, such as performance measures, appropriate use criteria, and both quality improvement and clinical decision support tools.The American College of Cardiology Foundation ACCF and the American Heart Association AHA have jointly produced guidelines in the area of cardiovascular disease since 1.The ACCFAHA Task Force on Practice Guidelines Task Force, charged with developing, updating, and revising practice guidelines for cardiovascular diseases and procedures, directs and oversees this effort.Writing committees are charged with regularly reviewing and evaluating all available evidence to develop balanced, patient centric recommendations for clinical practice.Experts in the subject under consideration are selected by the ACCF and AHA to examine subject specific data and write guidelines in partnership with representatives from other medical organizations and specialty groups.Writing committees are asked to perform a formal literature review weigh the strength of evidence for or against particular tests, treatments, or procedures and include estimates of expected outcomes where such data exist.Patient specific modifiers, comorbidities, and issues of patient preference that may influence the choice of tests or therapies are considered.When available, information from studies on cost is considered, but data on efficacy and outcomes constitute the primary basis for the recommendations contained herein.In analyzing the data and developing recommendations and supporting text, the writing committee uses evidence based methodologies developed by the Task Force.The Class of Recommendation COR is an estimate of the size of the treatment effect considering risks versus benefits in addition to evidence andor agreement that a given treatment or procedure is or is not usefuleffective or in some situations may cause harm.The Level of Evidence LOE is an estimate of the certainty or precision of the treatment effect.The writing committee reviews and ranks evidence supporting each recommendation with the weight of evidence ranked as LOE A, B, or C according to specific definitions that are included in Table 1.Studies are identified as observational, retrospective, prospective, or randomized where appropriate.For certain conditions for which inadequate data are available, recommendations are based on expert consensus and clinical experience and are ranked as LOE C.
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