Interventions for ST-segment elevation acute myocardial infarction

Summary

Early reperfusion therapy is a life-saving treatment for patients with ST-segment elevation myocardial infarction. Primary PCI is the preferred method of reperfusion. However, the advantages of the invasive approach over fibrinolytic therapy may be reduced by late initiation of mechanical reperfusion due to logistical problems related to transportation delay to a hospital with a 24/7 invasive service. To overcome this limitation, regional programmes of the treatment of acute coronary syndromes are being introduced based on the cooperation of a PCI-capable hospital (hub) with ambulances and non-PCI-capable hospitals (spokes). With appropriate planning, only in a small minority of patients the anticipated delay to primary PCI will be so long to require pre- or in-hospital fibrinolytic therapy as a bridge to invasive therapy. PCI technique, as well as adjunctive pharmacotherapy in ST-segment elevation myocardial infarction treatment, differ from standard PCI for stable angina due to the need for rapid intervention on thrombus-containing lesions, which increases the risk of complications including distal embolisation or no-reflow. Modern aggressive antiplatelet therapy and new stent designs have improved the immediate and long-term results of primary PCI.

Networking of acute myocardial infarction treatment

The annual incidence of hospital admission for ST-segment elevation myocardial infarction (STEMI) varies...