The AHA Guidelines and Scientific Statements Handbook

Chapter 3 ST-Elevation Myocardial Infarction

Fig. 3.10 Recommendations for secondary prevention after STEMI: diabetes management, weight management.

who are at low risk for bleeding and who can be
monitored adequately for dose adjustment to main-
tain a target INR range. (Level of Evidence: C)
4 At the time of preparation for hospital discharge,
the patient’s need for treatment of chronic muscu-
loskeletal discomfort should be assessed and a
stepped-care approach to pain management should
be used for selection of treatments (Figure 3.12).
Pain relief should begin with acetaminophen or
aspirin, small doses of narcotics, or non-acetylated
salicylates. (Level of Evidence: C) [17]

Class IIa
It is reasonable to use non-selective NSAIDs such as
naproxen if initial therapy with acetaminophen,
small doses of narcotics, or non-acetylated salicy-
lates is insuffi cient. (Level of Evidence: C)

Class IIb
NSAIDs with increasing degrees of relative COX-2
selectivity may be considered for pain relief only for
situations where intolerable discomfort persists
despite attempts at stepped-care therapy with acet-
aminophen, small doses of narcotics, non-acetylated
salicylates, or nonselective NSAIDs. In all cases, the

lowest effective doses should be used for the shortest

possible time. (Level of Evidence: C)

Class III

NSAIDs with increasing degrees of relative COX-2

selectivity should not be administered to STEMI

patients with chronic musculoskeletal discomfort

when therapy with acetaminophen, small doses of

narcotics, non-acetylated salicylates, or nonselective

NSAIDs provides acceptable levels of pain relief.

(Level of Evidence: C)

Long-term management

A. Psychosocial impact of STEMI

Class I

The psychosocial status of the patient should be

evaluated, including inquiries regarding symptoms

of depression, anxiety, or sleep disorders and the

social support environment. (Level of Evidence: C)

Class IIa

Treatment with cognitive-behavioral therapy and

selective serotonin reuptake inhibitors can be useful

for STEMI patients with depression that occurs in