Birkmeier S, Thiele H, Dörr R
Klinik für Innere Medizin/Kardiologie, Universität Leipzig - Herzzentrum, Strümpellstr. 39, 04289, Leipzig, Deutschland.
Herz. 2013 Dec;38(8):889-98; quiz 899. doi: 10.1007/s00059-013-3941-9.
This article gives an update on the management of ST-segment elevation myocardial infarction (STEMI) according to guidelines released in 2012 by the European Society of Cardiology. To ensure a reliable diagnosis the updated universal definition of myocardial infarction will also be covered which is defined by myocardial necrosis. Criteria for diagnosis are a rise or fall of cardiac biomarkers, preferably troponin, in conjunction with symptoms of myocardial ischemia, new repolarisation disorders or left bundle branch block, development of pathological Q-waves, new hypokinesia/akinesia or loss in viability or the detection of intracoronary thrombi during cardiac catheterization or autopsy. The current recommendations for primary diagnosis and treatment by the first medical contact will also be discussed and contains decision-making for the optimal reperfusion strategy. Primary percutaneous coronary intervention remains the preferred reperfusion strategy; however, specifications with respect to time for diagnosis and reperfusion have been introduced. Furthermore, establishing a STEMI network has been emphasized in more detail. Special attention is paid to the new antiplatelet agents and anticoagulation therapy where prasugrel and ticagrelor are currently preferred over clopidogrel.
本文根据欧洲心脏病学会2012年发布的指南，对ST段抬高型心肌梗死（STEMI）的管理进行了更新。为确保可靠诊断，还将涵盖心肌梗死的更新通用定义，该定义由心肌坏死确定。诊断标准为心脏生物标志物升高或降低，最好是肌钙蛋白，同时伴有心肌缺血症状、新的复极异常或左束支传导阻滞、病理性Q波形成、新的运动减弱/运动不能或存活能力丧失，或在心脏导管检查或尸检期间检测到冠状动脉内血栓。还将讨论首次医疗接触时的初步诊断和治疗的当前建议，其中包括最佳再灌注策略的决策。直接经皮冠状动脉介入治疗仍然是首选的再灌注策略；然而，已引入了关于诊断和再灌注时间的具体规定。此外，更详细地强调了建立STEMI网络。特别关注新型抗血小板药物和抗凝治疗，目前普拉格雷和替格瑞洛比氯吡格雷更受青睐。
