As in previous guidelines, the 2004 ACC/AHA Guidelines for the Management of Patients with AMI classify the indications

for diagnostic procedures, therapies, or interventions. Since the 1996 publication of the ACC/AHA Guidelines for Management of Patients with AMI, significant advances in pharmacological and mechanical therapies prompted the committee to revise some recommendations and add others that are now pertinent to clinical practice. The final recommendations for a diagnostic procedure, a particular therapy, or an intervention summarize both the evidence and expert opinion and are expressed in the ACC/AHA format as listed on this slide. The STEMI guideline provides a table for review of class and level of support for each recommendation From Table 1 Page 4 Executive Guidelines: Class I: Benefit >>>Risk - Procedure/Treatment SHOULD be performed/administered Class IIa: Benefit >>Risk Additional studies with focused objectives needed IT IS REASONABLE to perform procedure/administer treatment Class IIb: Benefit >Risk Additional studies with broad objectives needed; additional registry data would be helpful Procedure/Treatment MAY BE CONSIDERED Class III: Risk > Benefit No additional studies needed Procedure/Treatment should NOT be performed/administered SINCE IT IS NOT HELPFUL AND MAY BE HARMFUL As in previous guidelines, the 2004 ACC/AHA Guidelines for the Management of Patients with AMI classify the indications for diagnostic procedures, therapies, or interventions. Since the 1996 publication of the ACC/AHA Guidelines for Management of Patients with AMI, significant advances in pharmacological and mechanical therapies prompted the committee to revise some recommendations and add others that are now pertinent to clinical practice. The final recommendations for a diagnostic procedure, a particular therapy, or an intervention summarize both the evidence and expert opinion and are expressed in the ACC/AHA format as listed on this slide. The STEMI guideline provides a table for review of class and level of support for each recommendation From Table 1 Page 4 Executive Guidelines: Level A - Multiple (35) population risk strata evaluated * General consistency of direction and magnitude of effect Level B - Limited (23) population risk strata evaluated* Level C - Very limited (12) population risk strata evaluated * *Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as gender, age, history of diabetes, history of prior MI, history of heart failure, and prior aspirin use.

Exec Summary, pg 4.