Department of Medicine, New York Presbyterian Hospital, New York, NY, USA.
Minerva Med. 2012 Dec;103(6):431-9.
Treatment of acute ST-elevation myocardial infarction (STEMI) has rapidly evolved with many advances made in the past decade. Percutaneous coronary intervention is the preferred strategy when available, although there remains a role for thrombolytic therapy, with prompt reperfusion as the primary goal. With regards to antithrombotic therapy, bivalirudin now has a significant role in STEMI care with improved outcomes over unfractionated heparin plus GP IIb/IIIa inhibitors. Dual antiplatelet therapy has become a mainstay of treatment with combination of aspirin and clopidogrel, as well as an expanding role of more potent novel agents, prasugrel and ticagrelor. In primary PCI in STEMI, coronary stents are now being used routinely, although short-term and long-term outcomes of drug-eluting stents (DES) versus bare metal stents (BMS) continue to be studied. Recent meta-analyses have examined the trade-off of lower rates of in-stent restenosis and need for target vessel revascularization with DES versus the potential increase in the risk of stent thrombosis and need for longer course of dual antiplatelet therapy. This review will discuss the current STEMI guidelines and strategies, recent advances in pharmacotherapy, and data on stent selection.
急性 ST 段抬高型心肌梗死（STEMI）的治疗在过去十年中迅速发展，取得了许多进展。经皮冠状动脉介入治疗是首选策略，尽管溶栓治疗仍然有一定作用，主要目标是迅速再灌注。在抗血栓治疗方面，比伐卢定在 STEMI 治疗中具有重要作用，其疗效优于普通肝素加 GP IIb/IIIa 抑制剂。双联抗血小板治疗已成为治疗的基础，联合应用阿司匹林和氯吡格雷，以及更有效的新型药物普拉格雷和替格瑞洛的作用不断扩大。在 STEMI 的直接经皮冠状动脉介入治疗中，冠状动脉支架现在已常规使用，尽管药物洗脱支架（DES）与金属裸支架（BMS）的短期和长期结果仍在研究中。最近的荟萃分析研究了 DES 降低支架内再狭窄和需要靶血管血运重建的风险与支架血栓形成风险增加和需要更长时间双联抗血小板治疗之间的权衡。本文将讨论目前的 STEMI 指南和策略、药物治疗的最新进展以及支架选择的数据。
