Early and aggressive treatment of patients with acute ST segment elevation and non-ST segment elevation myocardial infarction leads to improved clinical outcomes.
Acute myocardial infarction remains a significant burden to our society. Despite being the number 1 cause of mortality, there remains no uniform approach to treatment, which is unlike that of the triage and care of trauma victims. It is now well documented that acute reperfusion therapy has a profound benefit; however, many current strategies take too long to be performed and thus those potential benefits are often reduced. The emergence of prehospital treatment as a means to reducing time to reperfusion provides a new avenue for earlier therapy. With a coordinated aggressive treatment strategy and the identification of primary cardiovascular centers dedicated to the treatment of ST segment elevation myocardial infarctions (STEMI), we believe the mortality of an STEMI can be significantly reduced. Similarly, the treatment of non-ST segment elevation myocardial infarction has shifted to an aggressive approach. Although thrombolytic therapy is not indicated, the use of glycoprotein IIb/IIIa antagonists, as well as early interventional revascularization, is the current preferred treatment strategy. We review important current trials that shape the practice of treatment as well as introduce a novel concept of combined prehospital administration of thrombolytics with urgent culprit artery revascularization.
Smalling
Richard W
RW
University of Texas Health Sciences Center at Houston Medical School, Houston, Texas, USA. Richard.w.smalling@uth.tmc.edu
Giesler
Gregory M
GM