Management of patients after primary percutaneous coronary intervention for myocardial infarction

• Published in: BMJ (Online) Vol. 358; no. 8115; p. j3237
• Main Authors: Dalal, Fatima, Dalal, Hasnain M, Voukalis, Christos, Gandhi, Manish M
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 20.07.2017
• Subjects: Aftercare - methods; Angioplasty; Ankle; Antiplatelet therapy; Bleeding; Cardiac arrhythmia; Cardiovascular disease; Cardiovascular diseases; Coronary artery disease; Drug addiction; Electrocardiography; Health Promotion - methods; Heart attacks; Heart diseases; Humans; Implants; Ischemia; Myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - prevention & control; Myocardial Infarction - surgery; Pain; Percutaneous Coronary Intervention; Physical activity; Postoperative Care - methods; Postoperative Complications - diagnosis; Postoperative Complications - therapy; Rehabilitation; Risk factors; Secondary Prevention - methods; Thrombosis; United Kingdom > UK
• ISSN: 1756-1833; 0959-8138; 1756-1833
• DOI: 10.1136/bmj.j3237

What you need to know Hospital discharge within three days after uncomplicated primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction is considered safe Advise patients to report any persistent discolouration, pain, or swelling over the arterial access site, and any new or recurrent chest pain, shortness of breath, palpitation, or ankle swelling Dual antiplatelet therapy is essential after primary PCI to prevent recurrent ischaemia and stent thrombosis, but can be associated with an increased bleeding risk After myocardial infarction, international guidelines recommend cardioprotective drugs and referral to a cardiac rehabilitation programme that promotes smoking cessation, physical activity, a healthy Mediterranean-style diet, and psychological support Annual review of symptoms, adherence to secondary prevention therapy, lifestyle change, and cardiovascular risk factors reduce recurrent cardiovascular events and improve survival For those who present with an acute ST elevation myocardial infarction (STEMI) in the UK, nearly 90% are treated with a primary angioplasty within 90 minutes of arrival at hospital. 1 One out of every seven deaths is due to coronary heart disease, with one person having a "heart attack" every 40 seconds, based on US data. 2 In the UK, 288 per 100000 people visit hospital with a suspected heart attack each year. 3 Patients are usually discharged three days after treatment for a STEMI with an uncomplicated primary percutaneous coronary intervention (PCI). Fig 1 Management of patients after an acute ST elevation myocardial infarction Sources and selection criteria We searched PubMed, Cochrane Library, Medline, and Google using the terms "secondary...