Acute management of myocardial infarction with ST-segment elevation: summary of NICE guidance.

This is one of a series of BMJ summaries of new guidelines based on the best available evidence; they highlight important recommendations for clinical practice, especially where uncertainty or controversy exists. Further information about the guidance, a list of members of the guideline development group, and the supporting evidence statements are in the full version on bmj.com. The incidence of myocardial infarction has been declining in the UK over the past 25 years, 2 but it varies between regions and still averages more than 600 hospitalised cases of ST-segment elevation myocardial infarction (STEMI) per million people each year. 4 The case fatality rates after myocardial infarction have also fallen, which has been attributed to improved access to effective treatments. The over-riding priority in the management of STEMI is to restore coronary perfusion rapidly and effectively, thereby limiting the extent of damage to myocardium and reducing the likelihood of death or future heart failure. Coronary reperfusion can be achieved by fibrinolysis (with agents such as reteplase and tenecteplase) or by mechanical reopening of the occluded artery by angioplasty and stent insertion (primary percutaneous coronary intervention). This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE) on the delivery of effective and timely coronary reperfusion treatment for people with STEMI.