465. ACS Guidelines Question #4 with Dr. Binita Shah

Managing ST-elevation myocardial infarction (STEMI) in patients at non-PCI-capable centers requires precise adherence to the 2025 ACS Guidelines regarding fibrinolytic therapy and antithrombotic regimens. Clopidogrel remains the only P2Y12 inhibitor with a Class I recommendation for use alongside fibrinolytic agents, with specific dosing adjustments for patients aged 75 and older to avoid loading doses and mitigate bleeding risks. Parenteral anticoagulation, specifically with enoxaparin, is essential to prevent re-occlusion during transfer, as supported by findings from the X-TRACT-STEMI-25 study. Dr. Binita Shah, an interventional cardiologist and member of the 2025 ACS Guidelines writing committee, emphasizes the necessity of these protocols when immediate PCI is unavailable or declined by the patient. Proper pharmacological management during the "drip and shift" process is critical to stabilizing patients and preventing recurrent ischemic events before they reach a PCI-capable facility.