title: Contemporary management of ST-segment elevation myocardial infarction.
abstract: ST-elevation myocardial infarction (STEMI), which constitutes nearly 25-40 % of current acute myocardial infarction (AMI) cases, is a medical emergency that requires prompt recognition and treatment. Since the 2013 STEMI practice guidelines, a wealth of additional data that may further advance optimal STEMI practices has emerged. These data highlight the importance of improving patient treatment and transport algorithms for STEMI from non-primary percutaneous coronary intervention (PCI) centers. In addition, a focus on the reduction of total pain-to-balloon (P2B) times rather than simply door-to-balloon (D2B) times may further improve outcomes after primary PCI for STEMI. The early administration of newer oral P2Y12 inhibitors, including crushed forms of these agents for faster absorption, represents another treatment advancement. Recent data also suggest avoiding concurrent morphine use due to interactions with P2Y12 inhibitors. Furthermore, new technological advancements and investigational therapies, including Bioresorbable Vascular Scaffolds and the use of pre-intervention intravenous microbubbles with transthoracic ultrasound, hold promise to play a useful role in future STEMI care. Despite these advancements, the prompt recognition of STEMI, at both the patient and health care system level, remains the cornerstone of optimal treatment.
authors.affiliation: Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA.
authors.forename: Ajay
authors.initials: A
authors.lastname: Yadlapati
authors.affiliation: Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Gajjar
authors.affiliation: Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Schimmel
authors.affiliation: Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Ricciardi
authors.affiliation: Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, 676 N. St. Clair Street, Suite 600, Chicago, IL, 60611-2996, USA. jflahert@nm.org.
authors.forename: James D
authors.initials: JD
authors.lastname: Flaherty
mesh_terms: D000700:Analgesics / Q000494:pharmacology / Q000627:therapeutic use; D000077144:Clopidogrel; D006801:Humans; D009020:Morphine / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000592:standards / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D000068799:Prasugrel Hydrochloride / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000072657:ST Elevation Myocardial Infarction / Q000628:therapy*; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D010975:Platelet Aggregation Inhibitors; D009020:Morphine; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D013988:Ticlopidine
keywords: Evolution; Guidelines; Perfusion; STEMI