This Guideline will be retired in November 2017.
Revision Date: November 2012
Scope and Target Population
Adults presenting with past or present symptoms of chest pain/discomfort and/or indications of acute cardiovascular syndromes.
- Increase the success of emergency intervention for patients with chest pain symptoms suggestive of serious illness.
- Minimize the delay in administering fibrinolysis or angioplasty to patients with acute myocardial infarction (AMI).
- Increase the timely initiation of treatment to reduce postinfarction mortality in patients with acute myocardial infarction.
- Increase the percentage of patients with acute myocardial infarction using cardiac rehabilitation.
- On initial contact with the health care system, high-risk patients need to be identified quickly and referred to an emergency department via the 911 system.
- Patients whose chest pain symptoms are suggestive of serious illness need immediate assessment in a monitored area and early therapy to include an immediate EKG, intravenous access, oxygen, aspirin and other appropriate medical therapies.
- Triage and management of patients with chest pain and unstable angina should be based on a validated risk assessment system and clinical findings.
- Patients with low-risk symptoms could be evaluated as outpatients.
- Thrombolysis for ST-elevation, MI or left bundle branch block should be instituted within 30 to 60 minutes of arrival, or angiogram/primary percutaneous coronary intervention should be performed within 90 minutes of arrival, with a target of less than 60 minutes. High-risk patients initially treated at non-PCI-capable facilities who cannot be transferred for PCI within 90 minutes should receive thrombolysis followed by as-soon-as-possible transfer to a PCI-capable facility.
- Recommend use of the following medications: P2Y12 inhibitor and aspirin (or P2Y12 inhibitor alone if aspirin allergic) at admission. Avoid P2Y12 inhibitor if cardiac surgery is anticipated. Use beta-blockers whenever possible and/or ACE inhibitors/angiotensin receptor blockers at 24 hours if stable, nitrates (when indicated), and statins whenever possible.
- Recommend use of cardiac rehabilitation.