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ACC/AHA Guidelines ACC/AHA Guidelines for the Management of Patients With ST-Elevation Acute Myocardial Infarction- Focus Emergency Care Writing Committee Task Force Members Writing Committee Members Elliott M. Antman, Chair Daniel T. Anbe, Paul Wayne Armstrong, Eric R. Bates, Lee A. Green, Mary Hand, Judith S. Hochman, Harlan M. Krumholz, Frederick G. Kuschner, Gervasio A. Lamas, Charles J. Mullany, Joseph P. Ornato, David L. Pearle, Michael A. Sloan, Sidney C. Smith, Jr. Task Force Members Elliott M. Antman, Chair Sidney C Smith, Jr.Vice Chair Joseph S. Alpert, Jeffery L. Anderson, David P. Faxon, Valentin Fuster, Raymond J. Gibbons, Gabriel Gregoratos, Jonathan L Halperin, Loren F. Hiratzka, Sharon Ann Hunt, Alice K. Jacobs, Joseph P. Ornato AMI Stats Incidence in the United States* Estimated 900,000 will suffer AMI this year ~565,000 will be new attacks (avg. age- 65.8yrs/males, 70.4yrs/female) ~300,000 will be recurrent attacks 42% of AMI pts will die within 1 year Approximately half of these deaths occur before reaching the emergency department Most cardiac deaths are the result of fatal arrhythmias Types of arrival/discharge AMIs** Upon arrival: STEMI on 1st ECG-26%; STEMI on 1st or subsequent ECG-35%; NSTEMI-65% Non-Q-wave: 75% Q-wave: 25% Pathophysiology of ST-Elevation Myocardial Infarction Recent Influences of Practice Superiority of Primary Percutaneous Coronary Intervention (PPCI) over fibrinolysis if Door-to-Balloon completed in a timely fashion Acknowledgement that Time Matters in PPCI Recommendations for time to reperfusion updated Studies published on Combination Therapy GP IIb/IIIa receptor antagonists in combination with ? dose fibrinolysis Studies with LMWH in treatment of STEMI (enoxaparin + full dose TNK-tPA) European STEMI trials influence the guidelines Prehospital, Transfer PCI?Prehospital Destination Protocols Classification of Recommendations Level of Evidence Achieve Coronary Patency Initial Reperfusion Therapy Defined as th