Treatment of ST-elevation myocardial infarction

In patients with ST-segment elevation myocardial infarction (STEMI), timely and adequate treatment may improve the prognosis dramatically. Restoration of the infarct vessel patency is one of the cornerstones of initial treatment. Compared with fibrinolytic therapy, primary percutaneous coronary intervention (PCI) results in improved short- and long-term survival, a lower incidence of recurrent infarction and a better left ventricular function. Although (drug-eluting) stents may reduce restenosis, effects on mortality are less clear. Administration of glycoprotein IIb/IIIa antagonists may further reduce periprocedural coronary complications, but bivalirudin may offer similar effects with less bleeding. beta-adrenergic blockers, angiotensin-converting-enzyme inhibitors and statins should be initiated in all patients with STEMI, although cautious use of beta-blockers is advised in patients at risk of cardiac shock. Patients with diabetes should receive optimal glucose control. High-risk patients, particularly those with a low ejection fraction, should receive an implantable cardioverter defibrillator after 30 days, although it is not clear whether patients who have received primary PCI also benefit, particularly if they have no signs of heart failure.