是时候在心肌梗死领域进行新的范式转变了。
Time for a new paradigm shift in myocardial infarction.
机构信息
Department of Cardiology, Marmara University Pendik Training and Research Hospital; İstanbul-Turkey.
Department of Emergency Medicine, Carolinas Medical Center, Charlotte; North Carolina-United States of America.
出版信息
Anatol J Cardiol. 2021 Mar;25(3):156-162. doi: 10.5152/AnatolJCardiol.2021.89304.
Abstract
The ST-elevation myocardial infarction (STEMI)/non-STEMI paradigm per the current guidelines has important limitations. It misses a substantial proportion of acute coronary occlusions (ACO) and results in a significant amount of unnecessary catheterization laboratory activations. It is not widely appreciated how poor is the evidence base for the STEMI criteria; the recommended STEMI cutoffs were not derived by comparing those with ACO with those without and not specifically designed for distinguishing patients who would benefit from emergency reperfusion. This review aimed to discuss the origins, evidence base, and limitations of STEMI/non-STEMI paradigm and to call for a new paradigm shift to the occlusion MI (OMI)/non-OMI.
摘要
现行指南中的 ST 段抬高型心肌梗死（STEMI）/非 ST 段抬高型心肌梗死（NSTEMI）范式存在重要局限性。它错过了相当一部分急性冠状动脉闭塞（ACO），并导致大量不必要的导管实验室激活。人们并没有广泛认识到 STEMI 标准的证据基础有多差；推荐的 STEMI 截止值不是通过比较有 ACO 的患者和没有 ACO 的患者得出的，也不是专门为区分那些将从紧急再灌注中获益的患者而设计的。本综述旨在讨论 STEMI/NSTEMI 范式的起源、证据基础和局限性，并呼吁向闭塞性心肌梗死（OMI）/非 OMI 范式转变。
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