The Living Guidelines: STEMI Recommendations for Inhibition of the Renin-Angiotensin-Aldosterone System Suggest Revisions to the CLASS I Guidelines

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Class I

 * 1) An ACE inhibitor should be prescribed at discharge for all patients without contraindications after STEMI. (Level of Evidence: A)
 * 2) Long-term aldosterone blockade should be prescribed for post-STEMI patients without significant renal dysfunction (creatinine should be less than or equal to 2.5 mg/dL in men and less than or equal to 2.0 mg/dL in women) or hyperkalemia (potassium should be less than or equal to 5.0 mEq/L) who are already receiving therapeutic doses of an ACE inhibitor, have an LVEF less than or equal to 0.40, and have either symptomatic heart failure or diabetes. (Level of Evidence: A)
 * 3) An ARB should be prescribed at discharge to those STEMI patients who are intolerant of an ACE inhibitor and have either clinical or radiological signs of heart failure and LVEF less than 0.40. Valsartan and candesartan have established efficacy for this recommendation. (Level of Evidence: B)