Cohen Marc, Arjomand Heidar, Pollack Charles V
Division of Cardiology, Newark Beth Israel Medical Center, Cardiac Cath Lav Administration, New Jersey 07112, USA.
Am J Emerg Med. 2004 Jan;22(1):14-23. doi: 10.1016/j.ajem.2003.09.001.
Acute ST-segment elevation myocardial infarction continues to be associated with substantial mortality rates. Despite much advancement in care, current treatments have also failed to eliminate the significant risk of morbidity, including reinfarction, reocclusion of the infarct-related artery, and thromboembolic stroke. The potential benefit of early thrombolytic therapy in reducing mortality was first established in 1986. Further benefits of conjunctive therapy with aspirin were demonstrated soon thereafter. This review examines the most significant trends in the pharmacologic therapy of ST-segment elevation myocardial infarction since the publication of these early studies: the development of fibrinolytic drugs with improved clot selectivity and improved pharmacokinetic profiles that simplify administration, making ED or even prehospital thrombolysis more practical. More recent data can be interpreted as showing that regimens that are simpler and easier to administer are also clinically superior. This article reviews pharmacologic advances and evaluates the evidence for their use in EDs.
急性ST段抬高型心肌梗死的死亡率仍然很高。尽管在治疗方面取得了很大进展，但目前的治疗方法也未能消除包括再梗死、梗死相关动脉再闭塞和血栓栓塞性中风在内的显著发病风险。早期溶栓治疗在降低死亡率方面的潜在益处最早于1986年得到证实。此后不久，阿司匹林联合治疗的进一步益处也得到了证明。本综述探讨了自这些早期研究发表以来，ST段抬高型心肌梗死药物治疗中最显著的趋势：开发具有改善的血栓选择性和药代动力学特征的纤溶药物，简化给药方式，使急诊科甚至院前溶栓更具可行性。最近的数据可以解释为表明，更简单、更容易给药的方案在临床上也更具优势。本文回顾了药物治疗的进展，并评估了其在急诊科应用的证据。
