Acute Myocardial Infarction复制标题

急性心肌梗死

Acute myocardial infarction with or without ST-segment elevation (STEMI or non-STEMI) is a common cardiac emergency, with the potential for substantial morbidity and mortality. The management of acute myocardial infarction has improved dramatically over the past three decades and continues to evolve. Emergency reperfusion of ischemic myocardium that is in the process of becoming infarcted is the most important advance in the treatment of STEMI over the past three decades and is the primary therapeutic goal. Coronary reperfusion is accomplished by means of primary PCI (angioplasty and stenting) or intravenous fibrinolytic therapy. Prompt PCI (with a performance goal of ≤90 minutes from the first medical contact) is the preferred approach at PCI-capable hospitals for STEMI with onset of symptoms within the previous 12 hours (ACC–AHA class I recommendation, evidence level A) and for STEMI with cardiogenic shock, regardless of the timing (ACC–AHA class I recommendation, evidence level B). The advantages of primary PCI over fibrinolysis include lower rates of early death, reinfarction, and intracranial hemorrhage. However, when PCI is delayed by more than 120 minutes, fibrinolytic therapy should be given if it is not contraindicated (ACC–AHA class I recommendation, evidence level A), followed by routine consideration of transfer in the following 3 to 24 hours to a PCI-capable facility (ACC–AHA class IIa recommendation, evidence level B). With broad application of reperfusion therapy for STEMI, 30-day mortality rates have progressively declined from more than 20% to less than 5%.

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