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Based on new evidence, the American College of Cardiology/American Heart Association have issued an update to their 2004 guidelines on management of ST-segment-elevation myocardial infarction (STEMI). We highlight some of the new and substantially modified recommendations.
Analgesia: Morphine still is recommended as the analgesic of choice for STEMI. However, for unstable angina or non-STEMI, use of morphine still is recommended, but the strength of the recommendation has been downgraded one class because of conflicting evidence about potential adverse effects in this population. With the exception of aspirin, nonsteroidal anti-inflammatory drugs — both nonselective and COX-2–selective agents — should be discontinued immediately in patients …