Thomas Deepak, Giugliano Robert P
Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
Crit Pathw Cardiol. 2010 Sep;9(3):126-33. doi: 10.1097/HPC.0b013e3181eaf53b.
The American College of Cardiology, American Heart Association and Society of Angiography and Intervention recently published updated guidelines for management of patients with acute ST elevation myocardial infarction (STEMI) and percutaneous coronary intervention (PCI). In this article, we highlight the most important new recommendations and review the supporting data. Key aspects of these updates include guidance regarding the selection of antithrombotic therapy, caution in treating hyperglycemia with insulin, and opinion that insufficient data currently exist to recommend against concomitant administration of proton pump inhibitors and thienopyridines. New interventional recommendations include support for aspiration thrombectomy, drug eluting stents, PCI of unprotected left main disease, and use of fractional flow reserve to guide whether PCI is warranted in symptomatic patients with intermediate coronary stenoses. As these guidelines represent a synopsis of the most recently available data in the management of patients with STEMI, health care providers should familiarize themselves with these updated recommendations to ensure optimal treatment of their patients.
美国心脏病学会、美国心脏协会以及血管造影与介入学会最近发布了关于急性ST段抬高型心肌梗死（STEMI）患者管理及经皮冠状动脉介入治疗（PCI）的更新指南。在本文中，我们重点介绍最重要的新建议并回顾相关支持数据。这些更新的关键内容包括抗栓治疗选择的指导、胰岛素治疗高血糖时需谨慎，以及目前尚无足够数据建议反对质子泵抑制剂与噻吩吡啶类药物联合使用的观点。新的介入治疗建议包括支持血栓抽吸术、药物洗脱支架、无保护左主干病变的PCI，以及使用血流储备分数来指导有症状的中度冠状动脉狭窄患者是否需要进行PCI。由于这些指南总结了STEMI患者管理方面的最新可用数据，医疗保健提供者应熟悉这些更新建议，以确保为患者提供最佳治疗。
