Vogel Rosanne F, Delewi Ronak, Badimon Lina, Angiolillo Dominick J, Vlachojannis Georgios J
Department of Cardiology, University Medical Center Utrecht, Utrecht University, 3584CX Utrecht, The Netherlands.
Department of Cardiology, Amsterdam UMC location AMC, University of Amsterdam, 1105AZ Amsterdam, The Netherlands.
Rev Cardiovasc Med. 2022 Sep 5;23(9):297. doi: 10.31083/j.rcm2309297. eCollection 2022 Sep.
Since the introduction of the first pharmacological therapy for the treatment of patients with acute myocardial infarction in the early 20th century, treatment of myocardial infarction has evolved extensively throughout the years. Mechanical revascularization therapies such as the percutaneous transluminal coronary angioplasty, combined with the ongoing development of pharmacological therapies have successfully improved the survival of patients with acute myocardial infarction. To date, antiplatelet therapy (consisting of aspirin and an oral inhibitor) and anticoagulation therapy represent the main stay of pharmacological treatment in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The routine use of clopidogrel as antiplatelet agent has been largely replaced by the use of the more potent inhibitors ticagrelor and prasugrel. Unfractionated heparin remains the preferred anticoagulant therapy, despite the development of other anticoagulants, including enoxaparin and bivalirudin. To date, limited evidence exists supporting a pre-hospital initiation of antiplatelet and anticoagulant therapy in STEMI patients. The use of potent intravenous antiplatelet agents, including the glycoprotein IIb/IIIa inhibitors and the intravenous inhibitor cangrelor, is currently restricted to specific clinical settings. While several potent antithrombotic agents already exist, the search for novel potent antithrombotic agents continues, with a focus on balancing antithrombotic properties with an improved safety profile to reduce excess bleeding. This review provides an overview of currently available pharmacological therapies for the treatment of STEMI patients undergoing primary PCI, and an outlook for the ongoing development of novel agents in this field.
自20世纪初首次引入治疗急性心肌梗死患者的药物疗法以来，多年来心肌梗死的治疗已经有了广泛的发展。经皮腔内冠状动脉成形术等机械血运重建疗法，结合药物疗法的不断发展，成功提高了急性心肌梗死患者的生存率。迄今为止，抗血小板治疗（由阿司匹林和口服抑制剂组成）和抗凝治疗是接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者药物治疗的主要手段。氯吡格雷作为抗血小板药物的常规使用在很大程度上已被更有效的抑制剂替格瑞洛和普拉格雷所取代。尽管包括依诺肝素和比伐卢定在内的其他抗凝剂有所发展，但普通肝素仍然是首选的抗凝治疗药物。迄今为止，支持在STEMI患者院前启动抗血小板和抗凝治疗的证据有限。强效静脉抗血小板药物的使用，包括糖蛋白IIb/IIIa抑制剂和静脉抑制剂坎格雷洛，目前仅限于特定临床情况。虽然已经有几种强效抗血栓药物，但寻找新型强效抗血栓药物的工作仍在继续，重点是在抗血栓特性与改善安全性之间取得平衡，以减少过量出血。本综述概述了目前用于治疗接受直接PCI的STEMI患者的药物疗法，并展望了该领域新型药物的持续研发情况。
