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News from the American Heart Association
Date:12/10/2007

c therapy followed by immediate PCI may be harmful. However, facilitated PCI using regimens other than full-dose fibrinolytic therapy might be considered for restoring blood flow when all of the following are present: 1) patients are at high risk; 2) PCI is not immediately available within 90 minutes; and 3) bleeding risk is low.

Rescue PCI is recommended for patients who have received fibrinolytic therapy and have any of the following: 1) cardiogenic shock in patients less than 75 years of age who are suitable candidates for revascularization; 2) severe congestive heart failure and/or pulmonary edema; 3) hemodynamically compromising ventricular arrhythmias.

The guidelines also include new recommendations on using anticoagulants. Patients undergoing reperfusion with fibrinolytics should receive anticoagulant therapy for at least 48 hours and preferably for the duration of the initial hospital stay, up to eight days.

According to the update, clopidogrel should be added to aspirin in patients with STEMI regardless of whether they undergo reperfusion with fibrinolytic therapy or do not receive reperfusion therapy. Treatment with clopidogrel should continue for at least 14 days.

Recommendations regarding the initial treatment of STEMI retain the same goal - to restore blood flow to the heart as quickly as possible, primarily through the artery opening procedure called percutaneous coronary intervention (PCI).

Finally, among the most notable changes in the update is the recommendation that patients who routinely use COX-2 inhibitors and non-steroidal anti-inflammatory drugs (NSAIDs) - except aspirin - should stop taking them while being treated for a heart attack. NSAIDs are anti-inflammatory drugs that reduce pain, fever and inflammation. Cox-2 inhibitors are a kind of NSAID that directly targets the COX-2 enzyme, which causes inflammation and pain.

"The updated opinion on COX-2 inhibitors and other NSAIDs comes alon
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SOURCE American Heart Association; American College of Cardiology
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