STEMI guidelines: from formulation to implementation.

Introduction In general, guidelines reflect scientific evidence already acquired and follow, rather than anticipate, new developments in diagnostic and therapeutic practice. This applies to STEMI guidelines. Failure to apply the guidelines is rarely caused by the lack of knowledge of their content. Resistance is invariably due to scepticism as to the true advantage of the treatment proposed, financial concerns or organisational difficulties. In the last 10 years the guidelines surrounding STEMI treatment have evolved from a list of drugs able to respond to the various needs of STEMI patients (from pain relief to haemodynamic stabilisation and antithrombotic treatment) to an integrated strategy describing in detail the response to this primary cardiovascular emergency (from the first diagnosis and treatment in the ambulance to rehabilitation and secondary prevention). This article reports the key messages of the guidelines addressing STEMI treatment in the past 10 years and reviews how these messages have informed key changes in clinical practice.