Patient handout

STEMI / OMI (acute coronary syndrome)

PRODUCTION

1. Your condition

This handout is for stemi / omi (acute coronary syndrome). Your care team identified this based on: ischemic chest pain / anginal equivalent (acc/aha 2025 class i).

Other reasons your team may use this plan: ecg stemi / omi / sgarbossa+ / de winter / wellens (esc 2023; sgarbossa nejm 1996; de winter nejm 2008); rising troponin in ischemic context (4th universal definition of mi 2018); post-arrest rosc with ischemic ecg (acc/aha 2025 class i).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
aspirin	162–325 mg chewed	PO	once now then 81 mg daily	2025 ACC/AHA Class I — chewed non-enteric ASA at first medical contact
ticagrelor	180 mg load	PO	once now then 90 mg BID × 12 mo	PLATO 2009 — preferred over clopidogrel for primary PCI per ACC/AHA 2025 Class I; AVOID with prior ICH
prasugrel	60 mg load	PO	once now then 10 mg daily × 12 mo (5 mg if <60 kg or ≥75 yo)	TRITON-TIMI 38 2007 — preferred in PCI-eligible without stroke history per ACC/AHA 2025 Class I
clopidogrel	600 mg load (PCI) or 300 mg (lytic)	PO	once now then 75 mg daily × 12 mo	CLARITY-TIMI 28 — default if ticagrelor/prasugrel contraindicated; standard with fibrinolysis per ACC/AHA 2025 Class I
nitroglycerin	0.4 mg SL q5min × 3 → IV 5–10 µg/min titrated	SL/IV	PRN ischemic pain; continuous IV if HF/HTN	ACC/AHA 2025 Class III — AVOID if RV infarct, SBP <90, or PDE5 inhibitor in last 24–48 h
morphine	2–4 mg IV	IV	q5–15 min PRN	ACC/AHA 2025 Class IIb — reserve for ongoing pain; may slow P2Y12 absorption (CRUSADE registry)

Plan: STEMI acute — reperfusion + adjunctive antiplatelet/anticoagulant/anti-ischemic per ACC/AHA 2025

3. When to call your provider

Contact your care team if any of the following happen:

Recurrent angina / new positive stress test → repeat angiography per ACC/AHA 2025 Class I
New decompensated HF → escalate to cardio.acute-hf.core.v1
New AF → CHA2DS2-VASc + anticoagulation decision; rate vs rhythm per ACC/AHA 2023 AF guideline
Major bleed on antithrombotic → hold + multidisciplinary review
PHQ-9 ≥10 → mental health referral

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

On-site PCI cannot be delivered within 90 min OR FMC-to-device cannot be delivered within 120 min per ACC/AHA 2025 Class I
STEMI + SBP <90 + lactate ≥2 + hypoperfusion (cool extremities, AKI, AMS) per SCAI staging (Baran et al 2019)(life-threatening)
New systolic murmur + decompensation 3–7 d post-MI (acute MR from papillary rupture, VSR, free-wall rupture) per ACC/AHA 2025 Class I(life-threatening)
Sustained VT or VF after STEMI per ACC/AHA 2025(life-threatening)
No ST resolution ≥50% at 60–90 min post-lytic OR persistent pain / hemodynamic instability per REACT 2005
Inferior STEMI + RV infarct on V4R + hypotension per ACC/AHA 2025

6. Sources

Guideline: 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS Guideline + 2023 ESC ACS Guidelines