Groups collaborate to update AMI guidelines

For the first time since 1996, the American Heart Association and the American College of Cardiology have worked together to update management guidelines for acute myocardial infarction (AMI).

The new guidelines include increased support for the use of beta-blockers in patients with left ventricular failure and suggest that beta-blockers be considered for patients in whom MI has occurred without ST segment elevation.

Also in the absence of ST segment elevation in patients with acute MI, the guidelines recommend that either subQ low molecular weight heparin or IV unfractionated heparin should be administered. Also in cases of AMI without ST segment elevation, the guidelines recommend treatment with glycoprotein Iib/IIIa receptor antagonists for patients with high-risk or refractory ischemia.

Among other items, the guidelines also recommend lowering initial dosing of heparin with its unfractionated form is used with alteplase. Bypass or angioplasty is recommended for patients younger than 75 who are in cardiogenic shock.

For female patients, the guidelines recommend that any hormone replacement therapy should not follow MI, but in cases where estrogen and progestin therapies began prior to MI, those therapies can continue.

[Editor’s note: For additional information and access to the complete guidelines, contact the American Heart Association. Telephone: (214) 373-6300. Web:]