Mignatti Andrea, Echarte-Morales Julio, Sturla Matteo, Latib Azeem
Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, New York, NY 10467, USA.
J Clin Med. 2025 Jan 20;14(2):653. doi: 10.3390/jcm14020653.
Primary percutaneous coronary intervention (PCI) has revolutionized the management of ST-elevation myocardial infarction (STEMI), markedly improving patient outcomes. Despite technological advancements, pharmacological innovations, and refined interventional techniques, STEMI prognosis remains burdened by a persistent incidence of cardiac death and heart failure (HF), with mortality rates plateauing over the last decade. This review examines current practices in primary PCI, focusing on critical factors influencing patient outcomes. Moreover, it explores future developments, emphasizing the role of microvascular dysfunction-a critical but often under-recognized contributor to adverse outcomes, including incident HF and mortality, and has emerged as a key therapeutic frontier. Strategies aimed at preserving microvascular function, mitigating ischemia-reperfusion injury, and reducing infarct size are discussed as potential avenues for improving STEMI management. By addressing these challenges, the field can advance toward more personalized and effective interventions, potentially breaking the current deadlock in mortality rates and improving longer-term prognosis.
直接经皮冠状动脉介入治疗（PCI）彻底改变了ST段抬高型心肌梗死（STEMI）的治疗方式，显著改善了患者的预后。尽管有技术进步、药物创新和精细的介入技术，但STEMI的预后仍因心脏死亡和心力衰竭（HF）的持续发生率而负担沉重，死亡率在过去十年中趋于平稳。本综述探讨了直接PCI的当前实践，重点关注影响患者预后的关键因素。此外，还探讨了未来的发展，强调微血管功能障碍的作用——这是导致不良后果（包括新发HF和死亡）的一个关键但往往未被充分认识的因素，并且已成为一个关键的治疗前沿领域。旨在保护微血管功能、减轻缺血再灌注损伤和缩小梗死面积的策略被作为改善STEMI管理的潜在途径进行了讨论。通过应对这些挑战，该领域可以朝着更个性化和有效的干预措施迈进，有可能打破目前死亡率的僵局并改善长期预后。
