Heintzen M P
Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Klinik II, Klinikum Braunschweig gGmbH, Braunschweig.
Dtsch Med Wochenschr. 2008 Dec;133 Suppl 8:S266-9. doi: 10.1055/s-0028-1100959. Epub 2008 Dec 15.
Rapid revascularization of every presenting patient is the goal of modern therapy of ST-elevation myocardial infarction (STEMI). With respect to the current situation at least one half of all these patients will be treated medically using thrombolysis, prehospital or in hospital. Invasive diagnosis and revascularization (percutaneous intervention [PCI], coronary artery to bypass graft [CABG]) should be done promptly. Primary PCI performed in a timely manner by experienced interventional cardiologists in specialized centers is the best option in the management of patients with STEMI. Transfer PCI is an effective method of treatment for patients initially admitted to a hospital without PCI facilities and should be completed within 90 minutes of transfer time. Rescue-PCI following unsuccessful thrombolysis (< 50 % ST-resolution 90 minutes post thrombolysis) improves prognosis by restoring coronary flow. If planned immediate PCI after thrombolytic therapy is not indicated, PCI immediately after high dosage of glycoprotein IIb/IIIa-Inhibitors in combination with a high dose of clopidogrel may give good results.
让每一位就诊患者迅速实现血管再通是ST段抬高型心肌梗死（STEMI）现代治疗的目标。就目前情况而言，所有这些患者中至少有一半将接受药物溶栓治疗，无论是在院前还是院内。应及时进行有创诊断和血管再通（经皮介入治疗[PCI]、冠状动脉旁路移植术[CABG]）。由经验丰富的介入心脏病专家在专业中心及时进行的直接PCI是STEMI患者管理的最佳选择。转运PCI是最初入住无PCI设施医院的患者的一种有效治疗方法，应在转运时间90分钟内完成。溶栓失败后（溶栓后90分钟ST段回落<50%）进行补救性PCI可通过恢复冠状动脉血流改善预后。如果溶栓治疗后不适合立即进行计划中的直接PCI，那么在高剂量糖蛋白IIb/IIIa抑制剂联合高剂量氯吡格雷后立即进行PCI可能会取得良好效果。
