What are the key differences in the management of STEMI versus NSTEMI/UA in primary care?

Management of STEMI in primary care involves immediate assessment for eligibility for coronary reperfusion therapy, either primary PCI or fibrinolysis, and delivering reperfusion therapy as quickly as possible if indicated ¹.

For STEMI, early management includes offering a single loading dose of 300 mg aspirin as soon as possible, and avoiding routine use of glycoprotein IIb/IIIa inhibitors or fibrinolytics before arrival at the catheter laboratory if primary PCI is planned

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Coronary angiography with follow-on PCI is the preferred strategy for eligible STEMI patients if presentation is within 12 hours and PCI can be delivered within 120 minutes of fibrinolysis being an option

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In contrast, management of NSTEMI or unstable angina (UA) in primary care involves initial drug therapy, including antiplatelet agents such as prasugrel or ticagrelor if coronary angiography is planned, and consideration of conservative management without early coronary angiography for low-risk patients (predicted 6-month mortality 3.0% or less)

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For NSTEMI/UA, if PCI is not indicated, ticagrelor or clopidogrel may be used as part of dual antiplatelet therapy, and management may be conservative with delayed or no immediate invasive procedures

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