Elmariah Sammy, Smith Sidney C, Fuster Valentin
Mount Sinai Medical Center, New York, NY, USA.
Nat Clin Pract Cardiovasc Med. 2008 Jan;5(1):42-52. doi: 10.1038/ncpcardio1056.
ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality, but timely reperfusion is known to result in dramatically improved patient outcomes. As many as 40% of patients with STEMI, however, present late after symptom onset, which reduces the likelihood of them receiving reperfusion therapy. The past two decades have been plagued with controversy regarding the relative benefits of reperfusion therapy after 12 h from symptom onset. Despite considerable data supporting late reperfusion and the 'late open-artery hypothesis', recent studies have demonstrated a lack of benefit with late reperfusion. Moreover, advances in the medical management of STEMI have dramatically reduced morbidity and mortality, further challenging the need for more-invasive techniques. Numerous questions have arisen regarding the appropriate management and risk stratification of asymptomatic post-STEMI patients who present late after symptom onset. In light of recent data, we present a Review of late reperfusion in STEMI, specifically highlighting the effects of current medical therapies, risk-stratification techniques, and indications for the use of late reperfusion over medical management.
ST段抬高型心肌梗死（STEMI）与高发病率和高死亡率相关，但已知及时再灌注可显著改善患者预后。然而，多达40%的STEMI患者在症状发作后就诊延迟，这降低了他们接受再灌注治疗的可能性。在过去的二十年里，对于症状发作12小时后再灌注治疗的相对益处一直存在争议。尽管有大量数据支持延迟再灌注和“延迟开通动脉假说”，但最近的研究表明延迟再灌注并无益处。此外，STEMI医疗管理的进展显著降低了发病率和死亡率，这进一步对更具侵入性技术的必要性提出了挑战。对于症状发作后就诊延迟的无症状STEMI后患者的适当管理和风险分层，出现了许多问题。鉴于最近的数据，我们对STEMI中的延迟再灌注进行了综述，特别强调了当前药物治疗的效果、风险分层技术以及延迟再灌注相对于药物治疗的使用指征。
