STEMI & NSTEMI in the ICU

Heart & Circulation · ICU Decoded chapter 17 · Locked — free with a referral

By Dr Javed Akhtar · Last reviewed 3 October 2026

Cited to ACC/AHA STEMI; ESC ACS 2023.

Key points

STEMI: reperfuse without delay — PCI <90 min; lytics when PCI is >120 min away; give DAPT (aspirin + ticagrelor) + anticoagulation.
NSTEMI: GRACE risk-stratify; early invasive <24 h if high-risk/refractory; DAPT matched to bleeding risk.
Type 2 MI: fix the underlying supply-demand mismatch (sepsis, AF, anemia) rather than sending everyone to cath.
Complications to anticipate: VT/VF, papillary rupture, VSD, tamponade, RV infarct (nitrates contraindicated).
Radial access is preferred (Class 1) for PCI, and complete revascularization is Class 1 in STEMI with multivessel disease.

Investigations

First tests: 12-lead ECG, High-sensitivity cardiac troponin, Full blood count, Sodium, potassium, bicarbonate, urea and creatinine, Bedside echocardiography.

Only if indicated: Right-sided / posterior ECG leads, Coronary angiography.

Repeat monitoring: Continuous ECG monitoring.

Management pathways in this chapter

Goals and Therapy of ST-Segment Elevation Myocardial Infarction/ST-Segment
Risk Stratification and Therapy of Non–ST-Segment Elevation Myocardial Infarction
Managing Type 2 Myocardial Infarction

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Each pathway step by step, with its decision points
Treatment orders with doses
Why and when to send each test

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