Practice Clinical updates

Management of patients after primary percutaneous coronary intervention for myocardial infarction

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3237 (Published 20 July 2017) Cite this as: BMJ 2017;358:j3237
  1. Fatima Dalal, foundation year 2 doctor1,
  2. Hasnain M Dalal, honorary clinical associate professor2,
  3. Christos Voukalis, clinical research fellow in cardiology3,
  4. Manish M Gandhi, consultant cardiologist4
  1. 1Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK
  2. 2University of Exeter Medical School (Primary Care), Truro Campus, Truro TR1 3HD, UK
  3. 3Institute of Cardiovascular Sciences, University of Birmingham, Birmingham B15 2TT, UK
  4. 4Cardiac Department, Royal Devon and Exeter NHS Foundation Trust, Exeter EX2 5DW, UK
  1. Correspondence to: H M Dalal hmdalal{at}doctors.net.uk

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 100 000 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).1 4 They may present in the community for further advice shortly after discharge, so close collaboration between the cardiologist and the wider healthcare team is essential.5 This article provides an update on the immediate and longer term management of such patients (see fig 1).

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 prevention after a myocardial infarction,” “secondary prevention after a heart attack,” …

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