The Living Guidelines: STEMI Recommendations for Inhibition of the Renin-Angiotensin-Aldosterone System Polling Results for CLASS I Guidelines

Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the disclaimers page for important information regarding limitations of the information found here. In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme be used. Read more about the classification scheme used by the ACC / AHA Guidelines Committee here.

Class I Guidelines
1. An ACE inhibitor should be prescribed at discharge for all patients without contraindications after STEMI. (Level of Evidence: A)

 AHA / ACC 2007 STEMI Guidelines Inhibition of the Renin-Angiotensin-Aldosterone System Class I Recommendation 1 should be CLASS I CLASS IIa CLASS IIb CLASS III

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)

 AHA / ACC 2007 STEMI Guidelines Inhibition of the Renin-Angiotensin-Aldosterone System Class I Recommendation 2 should be CLASS I CLASS IIa CLASS IIb CLASS III

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)

 AHA / ACC 2007 STEMI Guidelines Inhibition of the Renin-Angiotensin-Aldosterone System Class I Recommendation 3 should be CLASS I CLASS IIa CLASS IIb CLASS III