Singh Kanwar P, Harrington Robert A
Pat and Jim Calhoun Cardiovascular Center, University of Connecticut, Farmington, CT 06030, USA.
Med Clin North Am. 2007 Jul;91(4):639-55; x-xi. doi: 10.1016/j.mcna.2007.03.008.
Primary percutaneous coronary intervention (PCI) has emerged as the preferred therapy for acute ST-segment elevation myocardial infarction (STEMI), as multiple randomized clinical trials and pooled analyses have shown improved clinical outcomes compared with medical reperfusion. Unfortunately, medical centers with 24-hour PCI capability are concentrated in urban areas, relegating many patients in the United States to inferior medical reperfusion. Ongoing substantial research efforts are directed at optimizing mechanical reperfusion, including refinements in adjuvant medical therapy and the use of drug-eluting stents in the catheterization laboratory. Research efforts are also focusing on the implementation of streamlined transfer systems from community centers to tertiary care centers, akin to systems used in the trauma model. Furthermore, experience with the performance of primary PCI at community centers without onsite surgical backup is growing. This article summarizes data regarding the current state, challenges, and future directions of primary PCI for STEMI, emphasizing adherence to current American College of Cardiology/American Heart Association guidelines.
直接经皮冠状动脉介入治疗（PCI）已成为急性ST段抬高型心肌梗死（STEMI）的首选治疗方法，因为多项随机临床试验和汇总分析表明，与药物再灌注相比，其临床结局有所改善。不幸的是，具备24小时PCI能力的医疗中心集中在城市地区，这使得美国许多患者只能接受较差的药物再灌注治疗。目前正在进行大量研究工作，旨在优化机械再灌注，包括改进辅助药物治疗以及在导管实验室使用药物洗脱支架。研究工作还集中在实施从社区中心到三级护理中心的简化转运系统，类似于创伤模式中使用的系统。此外，在没有现场手术支持的社区中心进行直接PCI的经验也在不断积累。本文总结了有关STEMI直接PCI的现状、挑战和未来方向的数据，强调要遵循美国心脏病学会/美国心脏协会的现行指南。
