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Results from clinical trials on ST-elevation myocardial infarction in a historic perspective with some

Jan Erik Otterstad1, Frank Brosstad

  • 1Division of Cardiology, Vestfold Hospital, Toensberg, Norway. jan.erik.otterstad@siv.no

Scandinavian Cardiovascular Journal : SCJ
|December 12, 2003
PubMed

Insights

Optimal treatment for ST-elevation myocardial infarction (STEMI) evolved from streptokinase to modern therapies. Current best practices involve bolus-teplase with low molecular weight heparin (LMWH) and aspirin, though primary percutaneous intervention (PCI) shows promise.

Area of Science:

  • Cardiology
  • Pharmacology
  • Interventional Cardiology

Background:

  • Acute ST-elevation myocardial infarction (STEMI) treatment has advanced significantly since early trials with streptokinase and aspirin.
  • Subsequent research focused on novel fibrinolytic agents, adjunctive heparin, and primary percutaneous intervention (PCI).

Purpose of the Study:

  • To provide a historical overview linking STEMI pathophysiology to treatment strategies.
  • To analyze major clinical trials evaluating drug combinations and PCI in STEMI management.

Main Methods:

  • Review of key clinical trials including GISSI-1, ISIS-2, GUSTO I, GUSTO III, ASSENT-2, and ASSENT-3.
  • Analysis of pathophysiology related to antiplatelet and antithrombin effects.
  • Discussion of primary PCI efficacy based on meta-analyses.

Main Results:

  • Optimal thrombolytic therapy for STEMI appears to be a combination of bolus-teplase (tenecteplase) and low molecular weight heparin (LMWH) alongside aspirin.
  • Primary PCI may be superior if performed within one hour of STEMI onset, but its universal applicability is debated.

Conclusions:

  • STEMI treatment has progressed from streptokinase/aspirin to bolus-teplase/LMWH/aspirin combinations over 15 years.
  • Primary PCI presents a potential alternative to fibrinolysis, requiring further large-scale comparative studies.
Abstract

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