Reperfusion strategies in acute ST-segment elevation myocardial infarction

PURPOSE OF REVIEW: Chronic heart disease is the leading cause of death in the United States, and coronary artery disease constitutes the number one cause among them. ST-segment elevation myocardial infarction comprises a large number of events per year in the United States. It is important to develop an integrated framework of reperfusion strategies to minimize ischemia among these patients. The objective of this review is to outline available reperfusion options, which can then form an evidence-based approach to implementing complementary pharmacologic and mechanical strategies that can enhance timely and effective coronary reperfusion. RECENT FINDINGS: The updated American College of Cardiology/American Heart Association clinical practice guidelines espouse the important goal of facilitating rapid recognition and treatment of patients who present acutely with ST-segment elevation myocardial infarction so that door-to-needle (or the first medical contact-to-needle) time for initiation of fibrinolytic therapy can be achieved within 30 min or door-to-balloon (or the first medical contact-to-balloon) time for primary percutaneous coronary intervention can be achieved within 90 min. SUMMARY: In conclusion, whatever reperfusion strategy is adopted, the ultimate objective should be to obtain prompt and effective reperfusion of ischemic myocardium as early as possible. The most efficacious and safe strategy for the treatment of ST-segment elevation myocardial infarction patients involves an integrated approach of highly organized networks to enhance the availability and use of primary percutaneous coronary intervention and to promote the selective use of fibrinolytic therapy, especially prehospital fibrinolysis, when primary percutaneous coronary intervention is not immediately available.