Management of ST segment elevation myocardial infarction

Mortality after acute ST elevation myocardial infarction (STEMI) has declined over past decades, partly attributed to significant improvements in patient management. In this chapter, we provide an up-to-date review of the current evidence-based management of STEMI, starting at the time of first medical contact. It is now well established that 'time is muscle', and we begin by defining the various strategic time points that are crucial to minimize the total ischaemic time, a major determinant of clinical outcomes. We then cover the salient features of the management of STEMI patients before, during and immediately after reperfusion therapy by primary percutaneous coronary intervention or thrombolytic therapy. It is important to bear in mind that the management of STEMI patients does not stop after discharge from hospital. A multidisciplinary approach is required to address a range of other physical and social aspects, ranging from lifestyle modification and exercise-based rehabilitation to assessment for primary prevention implantable cardioverter-defibrillator and advice regarding driving.