Unit of Cardiology Department of Internal Medicine, Heart Center University of Leipzig, Leipzig, Germany -
Minerva Med. 2013 Aug;104(4):391-411.
ST-elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality worldwide. Emergent reperfusion of the infarct related artery is the cornerstone of STEMI treatment in order to salvage myocardium and improve cardiovascular outcome. Basically, reperfusion strategies include fibrinolysis, primary percutaneous coronary intervention (PCI) or the combination of both methods. Clinical studies indicate that primary PCI is superior to fibrinolytic therapy when performed rapidly at experienced centers. However, physicians are often faced with the decision to either accept PCI-related delays due to transfer or to administer fibrinolysis immediately. A well structured regional system of STEMI care helps to select the appropriate reperfusion strategy and guarantee timely restoration of coronary blood flow. This article reviews the evidence behind the respective reperfusion therapies and summarizes current guidelines for STEMI management.
ST 段抬高型心肌梗死（STEMI）是全球范围内发病率和死亡率的主要原因。梗死相关动脉的紧急再灌注是 STEMI 治疗的基石，目的是挽救心肌并改善心血管结局。基本上，再灌注策略包括溶栓、直接经皮冠状动脉介入治疗（PCI）或这两种方法的联合应用。临床研究表明，在经验丰富的中心迅速进行时，直接 PCI 优于溶栓治疗。然而，医生经常面临着由于转院而接受 PCI 相关延迟或立即进行溶栓治疗的决策。一个结构良好的 STEMI 护理区域系统有助于选择适当的再灌注策略，并保证及时恢复冠状动脉血流。本文回顾了各自再灌注治疗的证据，并总结了 STEMI 管理的当前指南。
