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State of the art contemporary treatment of patients with ST elevationmyocardial infarction： pre- and in-hospital organization, devices anddrugs

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Chinese Medical Journal 2014年第6期127卷 1133-1140页

作者： Mikkel Malby Schoos Roxana Mehran The Zena and Michael A.Wiener Cardiovascular Institute The Icahn School of Medicine at Mount Sinai New York NY 10029-6574USA

Objective To review the presentation,diagnosis and recent developments in the pharmacological and invasive treatment of ST elevation myocardial infarction (STEMI) with a special focus on health-care organization in order to increase accessibility of primary pemutaneous coronary intervention (PCI).Data sources Data were obtained from English publications on STEMI *** formal systematic review was conducted,but an effort was made to be *** selection Studies were selected if they contained data relevant to the ***,data from clinical randomized trials,meta-analyses,guidelines and a few recent reviews are *** The described clinical approach to acute myocardial infarction (AMI) has been a continuum of scientific results and translation into clinical practice over the last four decades since the advent of thrombolytic *** has resulted in a dramatic in-hospital mortality decrease from 30% in the 1960s to the present 5%.The biggest survival benefits have undoubtedly been achieved after the advent of reperfusion *** contemporary treatment of STEMI,additional treatment effects on survival have to be sought in the very early admission phase,as the current mortality hazard drops significantly after the first critical days to continuously very low levels after *** Optimal treatment of STEMI patients is best performed with a widely accessible reperfusion strategy,preferably primary PCI,with contemporary peri-procedural anti-thrombotic treatment and device *** of reperfusion strategies is increased by efficient STEMI networks applying prehospital triage with digital tele-transmission of electrocardiograms (ECGs) and seamless patient transitions between health-care *** treatments of complicated STEMI with out-of hospital cardiac arrest and/or cardiogenic shock underline the necessity of structured referral systems,preferably immediately after the initial

关键词： acute myocardial infarction ST elevation myocardial infarction primary percutaneous coronary intervention fibrinolysis pre-hospital triage antiplatelet therapy antithrombotic therapy drug eluting stents cardiogenic shock out-ofhospital cardiac arrest

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