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.