The first step in the management of the patient with an acute ST elevation myocardial infarction (STEMI) is prompt recognition, since the beneficial effects of therapy with reperfusion are greatest when performed soon after presentation. For patients presenting to the emergency department with chest pain suspicious for an acute coronary syndrome (ACS), the diagnosis of STEMI can be confirmed by the electrocardiogram (ECG). Biomarkers may be normal early. (See "Criteria for the diagnosis of acute myocardial infarction" and "Initial evaluation and management of suspected acute coronary syndrome in the emergency department".)
Once the diagnosis of an acute STEMI is made, the early management of the patient involves the simultaneous achievement of several goals:
●Relief of ischemic pain.
●Assessment of the hemodynamic state and correction of abnormalities that are present.
●Initiation of reperfusion therapy with primary percutaneous coronary intervention (PCI) or fibrinolysis.