Contemporary Management of ST-Elevation Myocardial Infarction.
Recent advances have caused a major shift in the way ST-elevation myocardial infarctions are managed. This review explores the pharmacological and interventional techniques that have evidence for improving outcomes and the landmark trials that have sparked change. The new P2Y12inhibitors, ticagrelor and prasugrel, have been shown to be superior to clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention. Concurrently, many technical aspects of percutaneous coronary intervention have been further clarified by trial data, with bare-metal stents, routine thrombus aspiration and femoral access showing evidence of inferiority. Ongoing trials will provide more information on the role of non-culprit lesion PCI, bioresorbable vascular scaffolds, mechanical devices in persistent ischaemia and early automatic implantable cardioverter-defibrillators for inducible ventricular tachycardia.
Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
Ashleigh
A
Dind
Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
Usaid
U
Allahwala
Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia.
Kaleab N
KN
Asrress
Department of Medicine, Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
Sanjit S
SS
Jolly
Department of Cardiology, Royal North Shore Hospital, Sydney, NSW, Australia. Electronic address: ravinay.bhindi@sydney.edu.au.
Ravinay
R
Bhindi
D020341:Absorbable Implants; D000241:Adenosine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D001807:Blood Vessel Prosthesis; D006801:Humans; D062645:Percutaneous Coronary Intervention; D000068799:Prasugrel Hydrochloride / Q000627:therapeutic use*; D058912:Purinergic P2Y Receptor Agonists / Q000627:therapeutic use*; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D015607:Stents; D000077486:Ticagrelor
D058912:Purinergic P2Y Receptor Agonists; D000068799:Prasugrel Hydrochloride; D000077486:Ticagrelor; D000241:Adenosine
Non-culprit artery; P2Y(12) inhibitors; ST-Elevation Myocardial Infarction; Thrombus aspiration