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Practice Guidelines

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

BMJ 2013; 347 doi: (Published 10 July 2013) Cite this as: BMJ 2013;347:f4006
  1. Serena Carville, senior research fellow and project manager1,
  2. Martin Harker, health economist1,
  3. Robert Henderson, consultant cardiologist2,
  4. Huon Gray, consultant cardiologist3
  5. on behalf of the Guideline Development Group
  1. 1National Clinical Guideline Centre, Royal College of Physicians, London NW1 4LE, UK
  2. 2Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
  3. 3Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK
  1. Correspondence to: H Gray huon{at}

The incidence of myocardial infarction has been declining in the UK over the past 25 years,1 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.3 4 The case fatality rates after myocardial infarction have also fallen, which has been attributed to improved access to effective treatments.5 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.6


NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italics in square brackets.

Assess eligibility for coronary perfusion therapy

  • Immediately assess eligibility (irrespective of age, ethnicity, or sex) for coronary reperfusion (either primary percutaneous coronary intervention (PCI) or fibrinolysis) in people with acute STEMI. [Based on the experience and opinion of the Guideline Development Group (GDG), and absence of evidence for age, ethnicity, or sex differences]

  • Do not use level of consciousness after cardiac arrest caused by suspected acute STEMI to determine whether a person is eligible for coronary angiography (with follow-on primary PCI if indicated). [Based on the experience and opinion of the …

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