#Timi score for non stemi full

In patients unable to take aspirin: initial loading dose of 75 mg maintenance dosage of 75 mg per day With fibrinolytic therapy: initial loading dose of 300 mg for patients younger than 75 years and 75 mg for patients 75 years and older continue for at least 14 days and up to one year Initial loading dose of 300 or 600 mg, then 75 mg per day for up to 12 months in patients treated with an early invasive or ischemia-guided strategy With PCI: initial loading dose of 600 mg maintenance dosage of 75 mg per day for one year in patients who receive a stent Initial loading dose of 162 to 325 mg maintenance dosage of 81 to 325 mg per day With PCI or fibrinolytic therapy: initial loading dose of 162 to 325 mg maintenance dosage of 81 to 325 mg per day indefinitely after therapy Glycoprotein IIb/IIIa inhibitors (such as tirofiban, eptifibatide, and abciximab ) have shown benefit when used during PCI in persons with STEMI and as an adjunct to PCI in persons with NSTE-ACS however, triple antiplatelet therapy has been associated with an increased risk of bleeding. Clopidogrel, 75 mg per day, should be continued in patients receiving fibrinolytic treatment for at least 14 days and up to one year. Patients undergoing fibrinolysis for STEMI should receive a loading dose of clopidogrel (300 mg in persons younger than 75 years, or 75 mg in persons 75 years and older) before treatment. 4 For patients undergoing primary PCI for STEMI, a P2Y 12 receptor antagonist, such as clopidogrel (Plavix 600 mg), should be administered as early as possible or at the time of PCI, and a maintenance dosage of 75 mg per day should be continued for one year in patients who receive a stent. With either strategy, aspirin therapy (162 to 325 mg per day) should be started as soon as possible and continued indefinitely. 4, 5 Dual antiplatelet therapy is highly recommended in the treatment of STEMI to support primary PCI and fibrinolytic treatment strategies. Table 1 summarizes the medications used to manage ACS. The goal of medical management is to administer fibrinolytic therapy within 30 minutes of first medical contact. If none is available within a 30-minute travel time, medical management should occur in the nearest emergency department. Primary percutaneous coronary intervention (PCI) is the recommended reperfusion method therefore, all efforts should be made to transfer a patient with suspected STEMI to a PCI-capable hospital. 1 Part of the initial assessment also involves obtaining cardiac biomarkers that include troponin (I or T). Electrocardiographic findings that may reflect myocardial ischemia include changes in the PR segment, QRS complex, and the ST segment.

#Timi score for non stemi full

Initial care should include a full assessment of clinical symptoms and coronary artery disease risk factors, as well as 12-lead electrocardiography. 4 At the community level, local areas should create and maintain emergency medical service systems that support STEMI care. Post–myocardial infarction care should be closely coordinated with the patient's cardiologist and based on a comprehensive secondary prevention strategy to prevent recurrence, morbidity, and mortality.Īt the individual level, patients should be advised to chew a nonenteric coated aspirin (162 to 325 mg) at first recognition of ACS symptoms, unless they have a history of severe aspirin sensitivity. Fibrinolysis is not recommended in patients with non–ST elevation acute coronary syndrome therefore, these patients should be treated with medical management if they are at low risk of coronary events or if percutaneous coronary intervention cannot be performed. If percutaneous coronary intervention cannot be performed rapidly, patients with ST elevation myocardial infarction can be treated with fibrinolytic therapy. Coupled with appropriate medical management, percutaneous coronary intervention can improve short- and long-term outcomes following myocardial infarction.

Rapid reperfusion with primary percutaneous coronary intervention is the goal with either clinical presentation. Diagnosis can be made based on patient history, symptoms, electrocardiography findings, and cardiac biomarkers, which delineate between ST elevation myocardial infarction and non–ST elevation acute coronary syndrome. Family physicians need to identify and mitigate risk factors early, as well as recognize and respond to acute coronary syndrome events quickly in any clinical setting. Acute coronary syndrome continues to be a significant cause of morbidity and mortality in the United States.