Early and aggressive treatment of patients with ST-segment elevation myocardial infarction: deciphering recent clinical trials and the timing of optimal platelet inhibition

In patients with ST-segment elevation myocardial infarction (STEMI), early and effective revascularization is vital to an improved outcome. This not only involves enhancing blood flow through the infarct-related epicardial vessel, but also the restoring of perfusion to the myocardial tissue as it has been strongly linked to clinical outcome. Platelets hold a pivotal position in the distal embolization in patients with STEMI, particularly those who are managed with primary percutaneous coronary intervention, and therefore provide robust rationale to include intense inhibition of their management. Recent clinical studies focusing on STEMI and subanalyses from larger ACS trials reflecting contemporary practice including newer and higher-dose oral agents along with GP IIb/IIIa inhibitors, have painted a mixed picture as to the optimal treatment regimen. Together with dosing, timing of administration could be critical in determining the proper strategy as earlier administration may facilitate more rapid perfusion and ultimately reduce adverse events.