Treatment of ST-elevation myocardial infarction: state of the art and new horizons

Abstract

ST-segment elevation myocardial infarction (STEMI) is the most important acute manifestation of coronary artery disease and is associated with high morbidity and mortality. A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases. Early diagnosis and immediate reperfusion are the most effective ways to limit myocardial ischaemia and infarct size and thereby reduce the risk of complications and heart failure. Primary percutaneous coronary intervention has become the preferred reperfusion strategy in these patients; if angioplasty cannot be performed within 120 min of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus. The initiation of networks to provide around- the-clock cardiac catheterization availability and the generation of standard operating procedures within hospital systems have helped to reduce the time to reperfusion therapy. Together with new advances in antithrombotic therapy and preventive measures, these developments have resulted in a decrease in mortality. However, a substantial amount of patients still experience recurrent cardiovascular events after STEMI. New insights have been gained regarding the pathophysiology of STEMI and feed into the development of new treatment strategies.