From the Guidelines
The first treatment for myocardial infarction is immediate administration of aspirin and rapid transport to a hospital for primary percutaneous coronary intervention (PCI), which is the preferred reperfusion strategy when available within 90 minutes of first medical contact. This approach is based on the most recent and highest quality evidence, which prioritizes minimizing morbidity, mortality, and improving quality of life 1. The use of aspirin, typically 325 mg chewed for rapid absorption, is crucial as it inhibits platelet aggregation, preventing further clot formation in the coronary arteries.
Alongside aspirin, supplemental oxygen should be provided if oxygen saturation is low, and nitroglycerin (0.4 mg sublingual tablet or spray) can be given for chest pain relief. Pain management with morphine (2-4 mg IV) may be necessary, and additional medications like P2Y12 inhibitors (clopidogrel, ticagrelor) are typically started early. The goal of immediate treatment is to limit myocardial damage by restoring blood flow as quickly as possible.
Key considerations in the management of myocardial infarction include:
- Rapid assessment and initiation of treatment
- Use of aspirin and other antiplatelet agents
- Provision of supplemental oxygen and pain management
- Rapid transport to a hospital capable of performing primary PCI
- Consideration of thrombolysis if primary PCI is not available within 90 minutes of first medical contact, although primary PCI is preferred due to its superiority in reducing stroke and salvaging myocardium, especially in patients presenting 3-12 hours after the onset of chest pain 1.
It's also important to note that the choice between primary PCI and thrombolysis depends on the time from onset of symptoms and the availability of a PCI facility with an experienced team. Primary PCI is the treatment of choice in patients presenting with STEMI in a hospital with PCI facility and an experienced team, while thrombolysis is still a viable alternative if it can be delivered within 3 hours after onset of chest pain or other symptoms 1.
From the FDA Drug Label
INDICATIONS AND USAGE TNKase is a tissue plasminogen activator, indicated to reduce the risk of death associated with acute ST elevation myocardial infarction (STEMI). DOSAGE AND ADMINISTRATION Initiate treatment as soon as possible after the onset of STEMI symptoms.
The first treatment for myocardial infarction is thrombolysis with a tissue plasminogen activator such as tenecteplase, which should be initiated as soon as possible after the onset of STEMI symptoms.
- The treatment should be individualized based on the patient's weight.
- It is administered as a single bolus over 5 seconds.
- Percutaneous Coronary Intervention (PCI) may also be performed after administration of thrombolytic therapies if medically appropriate. 2
From the Research
First Treatment for Myocardial Infarction
- The first treatment for myocardial infarction typically involves the administration of aspirin, as it has been shown to provide rapid clinical antithrombotic effects 3.
- A loading dose of 162.5 to 325 mg of aspirin is often necessary to achieve this effect in acute myocardial infarction cases 3.
- Aspirin is used in combination with other antiplatelet therapies, such as clopidogrel, to reduce the occurrence of re-thrombosis after percutaneous coronary intervention (PCI) and improve cardiac function recovery 4.
- The choice of antiplatelet therapy and its duration can vary depending on the patient's specific condition and the presence of other risk factors 5, 6.
- Low-dose aspirin (75 to 160 mg/day) is generally recommended for short- and long-term use due to its efficacy and safety profile, with a lower incidence of gastrointestinal bleeding compared to higher doses 7.
Antiplatelet Therapy Options
- Aspirin and clopidogrel are commonly used in dual antiplatelet therapy (DAPT) for patients with acute coronary syndrome undergoing PCI 4, 6.
- Ticagrelor, a direct P2Y₁₂ receptor antagonist, is also used in DAPT and has been shown to be effective in reducing cardiovascular events and mortality in patients with acute coronary syndromes 5, 7.
- The optimal duration and choice of antiplatelet therapy can depend on various factors, including the patient's risk profile and the specific clinical scenario 6.