Guidelines
Medical guidelines are systematically developed aids for decision-making on the appropriate medical approach to specific health problems and provide guidance on the treatment of diseases. The current guidelines are published by the German Society for Cardiology, Heart and Circulation Research (Deutsche Gesellschaft für Kardiologie-, Herz- und Kreislaufforschung e. V.) and distinguish between infarcts with certain features in the electrocardiogram (with ST-segment elevation, STEMI) and without (without ST-segment elevation, NSTEMI). The infarct with the changes in the ECG (STEMI) is the more severe event, as it is usually caused by a complete blockage of a coronary vessel.
The guidelines state that the first therapeutic goal in this type of myocardial infarction is to reopen the occluded vessel as early as possible, either mechanically using a catheter or with medication (fibrinolysis). The method of choice in acute STEMI is to restore blood flow to the heart muscle by means of a cardiac catheter (PCI, percutaneous coronary intervention). The use of drug-eluting stents is recommended, unless the patient has an increased risk of bleeding due to other diseases.
In this case, pure metal stents should still be preferred.According to the guideline, the earlier this treatment is given, the greater the chances that the heart will survive the heart attack with only minor damage. The guideline on myocardial infarction also differentiates between the different types of catheter therapy. Catheter access via the arm artery should be preferred, but only if the treating physician has sufficient experience with this access route.
The rate of complications and bleeding is reduced with arm access compared to leg artery catheter access. A possibility of heart attack therapy via special catheters is also mentioned in the guidelines. In this case, the thrombi (blood clot that seals the vessel, which leads to the heart attack) can be aspirated immediately via special catheters.
After successful resuscitation after cardiac arrest, the guideline recommends cooling the patient (therapeutic hypothermia). Newly included in the guidelines are two antiplatelet drugs (prasugrel and ticagrelor), which inhibit the clumping of blood platelets and are often referred to in the vernacular as “blood thinners”. The two new drugs will be preferred to the older drug clopidogrel in the future.
A recommendation regarding lifestyle changes can also be found in the guidelines. Especially smoking should be stopped immediately by people who have an increased risk of heart attack.
