Evolving management of ST-segment elevation myocardial infarction: update on recent data.
Significant recent advances have been made in strategies for managing ST-segment elevation myocardial infarction (STEMI). Based on new findings, the American College of Cardiology (ACC) and the American Heart Association (AHA) have updated their guidelines for acute myocardial infarction (MI) with newer recommendations for STEMI management. Many of these recommendations focus on antithrombotic agents, with a movement toward lower doses of long-term aspirin and lower doses of unfractionated heparin (UFH). Studies have also been completed on the use of enoxaparin and fondaparinux as potential alternatives to heparin, and clinical trial data support the early use of glycoprotein IIb/IIIa inhibitors (along with aspirin, UFH, and clopidogrel) in patients undergoing primary percutaneous coronary intervention for acute STEMI. Clopidogrel has also been shown to improve angiographic and clinical outcomes in patients with STEMI who are undergoing thrombolysis or being treated medically. The new ACC/AHA recommendations support clopidogrel pretreatment and long-term therapy.
Cannon
Christopher P
CP
Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02115, USA. cpcannon@partners.org
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000503:physiopathology / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D015912:Thrombolytic Therapy; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014481:United States
D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin