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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Late medical versus interventional therapy for stable ST-segment elevation myocardial infarction
Sammy Elmariah1, Sidney C Smith, Valentin Fuster
1Mount Sinai Medical Center, New York, NY, USA.
Insights
Late reperfusion for ST-segment elevation myocardial infarction (STEMI) remains controversial. Recent data suggest medical management may be superior to late reperfusion in improving outcomes for STEMI patients presenting after 12 hours.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Research
Background:
- ST-segment elevation myocardial infarction (STEMI) carries significant morbidity and mortality.
- Timely reperfusion therapy improves patient outcomes in STEMI.
- A substantial proportion of STEMI patients present late, missing the window for optimal reperfusion.
Purpose of the Study:
- To review the current evidence on late reperfusion in STEMI.
- To evaluate the impact of advances in medical management on STEMI treatment.
- To discuss risk stratification and indications for late reperfusion versus medical management in STEMI.
Main Methods:
- Review of recent studies and clinical data on late reperfusion in STEMI.
- Analysis of the 'late open-artery hypothesis' in light of new findings.
- Evaluation of current medical therapies and risk-stratification techniques for STEMI.
Main Results:
- Controversy exists regarding the benefits of reperfusion therapy after 12 hours from STEMI symptom onset.
- Recent studies indicate a potential lack of benefit from late reperfusion.
- Advances in medical management have reduced STEMI morbidity and mortality.
Conclusions:
- The optimal management of late-presenting STEMI patients requires careful consideration.
- Risk stratification is crucial for asymptomatic post-STEMI patients presenting late.
- Indications for late reperfusion need re-evaluation in the context of modern medical therapies.
Abstract:
ST-segment elevation myocardial infarction (STEMI) is associated with high morbidity and mortality, but timely reperfusion is known to result in dramatically improved patient outcomes. As many as 40% of patients with STEMI, however, present late after symptom onset, which reduces the likelihood of them receiving reperfusion therapy. The past two decades have been plagued with controversy regarding the relative benefits of reperfusion therapy after 12 h from symptom onset. Despite considerable data supporting late reperfusion and the 'late open-artery hypothesis', recent studies have demonstrated a lack of benefit with late reperfusion. Moreover, advances in the medical management of STEMI have dramatically reduced morbidity and mortality, further challenging the need for more-invasive techniques. Numerous questions have arisen regarding the appropriate management and risk stratification of asymptomatic post-STEMI patients who present late after symptom onset. In light of recent data, we present a Review of late reperfusion in STEMI, specifically highlighting the effects of current medical therapies, risk-stratification techniques, and indications for the use of late reperfusion over medical management.
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