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Recomendación 1:
En adultos con IMCEST, recomendamos realizar la ICP primaria dentro de los primeros 120 minutos luego de establecido el diagnóstico de la enfermedad por EKG. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

BPC 1:
Se debe priorizar el uso de ICP en el menor tiempo posible para el tratamiento del IMCEST.

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Recomendación 1:
En pacientes adultos con IMCEST, donde el tiempo desde el diagnóstico por EKG a la realización de la ICP primaria es mayor de 120 minutos,  recomendamos brindar estrategia farmacoinvasiva (fibrinólisis seguida de intervención coronaria percutánea) en lugar de solo fibrinólisis. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

BPC 1:
En los pacientes adultos con IMCEST, en quienes se le realizó fibrinólisis y esta fue efectiva para la disolución del trombo, realizar ICP dentro de las 2 a 24 horas posterior a la fibrinólisis, como parte de una estrategia farmacoinvasiva

BPC 2:
En los pacientes adultos con IMCEST, en quienes se le realizó fibrinólisis y esta no fue efectiva para la disolución del trombo, realizar ICP de rescate de manera inmediata, como parte de una estrategia farmacoinvasiva.

BPC 3:
Considere la fibrinólisis efectiva cuando haya “caída” de la elevación del segmento ST > 50% a los 60-90 minutos del inicio de la administración del fibrinolítico, arritmia típica de reperfusión, y desaparición del dolor torácico.

BPC 4:
Considere brindar la fibrinólisis pre-hospitalaria (en ambulancia o en centro de salud sin capacidad de ICP), según disponibilidad.

BPC 5:
El cumplimiento de las estrategias de reperfusión recomendadas se debería dar en el marco de una red integrada de atención del paciente con infarto agudo de miocardio (esta red incluye los establecimientos de salud, sistema de ambulancias, tecnologías sanitaria  con protocolos de triaje y evaluación clínica del paciente con síntomas de IAM empleando herramientas de telemedicina, como se explicitan en el ejemplo del Anexo 4).

BPC 6:
Se deben de seguir las “recomendaciones” de manejo farmacológico coadyuvante en los pacientes con IMCEST establecidos en el Anexo 5.

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Recomendación 1:
En adultos con IMCEST hemodinamicamente estables y con enfermedad coronaria multivaso, recomendamos realizar ICP de todas las lesiones obstructivas severas no relacionadas con el infarto antes de salir de alta de la hospitalización primaria. (Recomendación fuerte a favor, certeza baja de la evidencia)

BPC 1:
En adultos con IMCEST en quienes se les realizará ICP multivaso, se debe considerar el estado del paciente, criterio clínico del médico, y recursos disponibles de la institución sanitaria donde se realizará la ICP, para decidir si la intervención se realizará en un solo procedimiento o por estadíos.

BPC 2:
En adultos con enfermedad multivaso, el método  para determinar la estenosis de las lesiones obstructivas no relacionadas con el infarto (angiográfico, reserva de flujo fraccional, u otros) quedará a criterio del cardiólogo intervencionista y según disponibilidad de recursos.

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Recomendación 1:
En adultos que han sufrido de IMCEST, recomendamos realizar ejercicios físicos como parte de un programa de rehabilitación cardiaca integral (apoyo psicológico, nutricional y control de factores de riesgo cardiovascular) una vez que el paciente es estabilizado. (Recomendación fuerte a favor, certeza muy baja de la evidencia)

BPC 1:
El programa de rehabilitación cardiaca integral está compuesto por los ejercicios físicos, apoyo psicológico, educación, control de factores de riesgo y cambios en el estilo de vida.

BPC 2:
La implementación de esta rehabilitación cardiaca integral estará a cargo de un equipo multidisciplinario capacitado liderado por el médico cardiólogo en conjunto con las enfermeras, nutricionistas, psicólogos y fisioterapeutas, e idealmente con una trabajadora social.

BPC 3:
La rehabilitación cardiaca empieza con una evaluación inicial por el médico cardiólogo para definir la modalidad, intensidad y gradualidad del ejercicio, según cada paciente (tratamiento individualizado); y siguiendo protocolos definidos por cada centro hospitalario.

BPC 4:
En pacientes post IMCEST, se prefiere iniciar la rehabilitación cardiaca integral desde las 24 horas posterior a su estabilización (fase I). La fase I inicia durante la hospitalización hasta el alta del paciente, mientras que la fase II inicia desde el alta. La fase II debe tener una duración mínima de 3 meses. Ambas fases deber realizarse bajo supervisión del equipo multidisciplinario de rehabilitación cardiaca.

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