Clinical recommendation	ACC/AHA LOE*	SORT rating
Patients with STEMI who present within 12 hours of symptom onset and who do not have contraindications should receive immediate reperfusion therapy with fibrinolysis or PCI.	Class I, LOE A	A
Patients with STEMI should immediately chew 162 to 325 mg of aspirin on recognition of symptoms, unless there is an absolute contraindication.	Class I, LOE A	A
Intravenous beta blockers should not be given to patients with STEMI. They may be considered for treatment of hypertension if there are no contraindications (see Table 1).	Class III, LOE A	A
Oral clopidogrel (Plavix) at a dosage of 75 mg daily should be added to aspirin therapy in patients with STEMI, whether or not they undergo reperfusion therapy.	Class I, LOE A	A
Oral beta blocker therapy should be initiated within 24 hours of STEMI in patients with no contraindications.	Class I, LOE B	B
Patients undergoing reperfusion with PCI or stenting should begin clopidogrel therapy. Duration of therapy varies, depending on the type of stent used (no stent, 14 days; bare-metal stent, at least one month but ideally one year unless patient is at increased risk of bleeding; drug-eluting stent, one year).	Class I, LOE B	B
Patients who routinely took nonsteroidal anti-inflammatory drugs (except for aspirin) before STEMI should discontinue these agents because of increased risks of mortality, reinfarction, hypertension, heart failure, and myocardial rupture.	Class I, LOE C	C