This guideline covers care and treatment of people aged 18 and over with a type of heart attack known as spontaneous onset of myocardial infarction with ST-segment elevation (STEMI). It aims to ensure that adults with STEMI are assessed and treated as soon as possible to minimise the damage to their heart. It also aims to help commissioners and healthcare professionals configure services so that people with STEMI can have the best outcomes.

Diagnosing STEMI is covered in NICE’s guideline on chest pain of recent onset.


This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Commissioners and providers
  • Adults with STEMI and their families and carers

Is this guideline up to date?

We reviewed the evidence in September 2016 and we are updating the recommendations on culprit versus complete revascularisation.

We also propose to combine this guideline with the clinical guidelines on unstable angina and NSTEMI: early management (CG94) and management of hyperglycaemia in acute coronary syndromes (CG130).  This is being done to ensure that recommendations on the management of acute coronary syndromes fall under 1 clinical guideline.

See the guidance in development page for progress on the update

 Next review: To be scheduled

How we develop NICE guidelines

This guideline was previously called myocardial infarction with ST-segment elevation: the acute management of myocardial infarction with ST-segment elevation.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)