STEMI interventions--a review of relevant clinical trials.
Major advances have been made in primary reperfusion and adjunctive therapies for STEMI. Mechanical reperfusion therapy has become the preferred reperfusion strategy for patients with STEMI. Outcomes have improved with the use of stents, platelet inhibitors, and with increased experience, and there is a promise that outcomes can become even better with new methods to enhance myocardial reperfusion and reduce reperfusion injury and with new anticoagulants and drug-eluting stents. Recent trends from the NRMI have shown that the frequency of use of primary PCI has increased and has surpassed lytic therapy, but primary PCI is used to treat only a minority of patients with STEMI. The major challenge for clinicians in the next decade will be to find new ways to make mechanical reperfusion more available, improve outcomes through the use of optimal adjuvant therapies and improved systems of care to speed primary PCI. The nation-wide effort to reduce door-to-balloon times has been launched by American Heart Association, with goal of making primary PCI more available to patients with STEMI.
Mehta
Sameer
S
Mercy Medical Center, Miami, Florida, USA. mehtas@bellsouth.net
Patlola
Raghotham R
RR
Cohen
Salomon
S
Falcao
Esther
E
Flores
Ana Isabel
AI
Soles
Estefania Oliveros
EO
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use; D000075202:Contraindications; D054855:Drug-Eluting Stents; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D007036:Hypothermia, Induced; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D015428:Myocardial Reperfusion Injury / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000191:economics; D013997:Time Factors
D000925:Anticoagulants; D000991:Antithrombins; D065427:Factor Xa Inhibitors; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex