ST段抬高心肌梗死(STEMI)是一个主要的健康问题, 甚至在目前急性心肌梗死的诊断和管理不断改善中也如此。STEMI在大约33％的患者中发生致命事件。 STEMI是唯一的第二位最严重的急性冠脉综合征(ACS)的后心源性猝死的形式。约29％心肌梗死的患者 经历过STEMI(1), 而47％的急性冠脉综合征(ACS)患者, 表现出STEMI(2)症状。 STEM是冠心病三要素之一, 其他两个分别是不稳定型心绞痛和非ST段抬高心肌梗死(NSTEMI), 三者构成已知冠心病要素。急性冠脉综合征的特点是急性缺血性胸痛(休息痛或劳累痛)与缺血性心电图变化(ST段抬高或压低或T反转)联系在一起。有无ST段抬高是STEMI区别于急性冠心病其他形式的特征。 NSTEMI和不稳定型心绞痛以有无心肌损伤标记物的上升加以区别[3-6。纤溶和经皮冠状动脉介入治疗(PCI), 最终在STEMI再灌注治疗。这些疗法已上一线, 改善梗死动脉通畅性, 减少梗死面积, 降低死亡率。时间敏感性STEMI要求一个或这两个疗法的快速实施[4-7。调查表明, 许多西方国家STEMI病人很难接触再灌注治疗法, 而选择了临床使用成熟的药物疗法, 至今仍是未处理疗法。高达三分之一的STEMI患者在症状出现12小时内仍没有接受再紧急灌注治疗, 尽管保健在改善[7-8, 但最近的一项研究显示, 80.9％, 在北京的STEMI患者接受再灌注治疗(81％为初始PCI;19％, 溶栓)。同时, 研究表明初始PCI是北京病人的主要再灌注疗法[9。本文旨在给出两个明确的STEMI再灌注疗法的重要细节。
ST segment elevation myocardial infarction (STEMI) is a major health concern even with the current improvements in diagnosing and managing acute MI.STEMI is still a fatal event in approximately 33% of patients.STEMI is only the second most severe form of acute coronary syndrome (ACS) after sudden cardiac death.About 29% of patients with myocardial infarction experience a STEMI (1),whereas 47% of acute coronary syndrome (ACS) patients present with STEMI (2).STEMI is one of the three components which constitute a spectrum of conditions known as acute coronary syndrome (ACS),the other two being unstable angina and Non-ST segment elevation myocardial infarction (NSTEMI).Acute coronary syndrome is characterized by a specific pattern of acute ischemic chest pain (either rest pain or minimal exertion),associated with ECG changes of ischemia (ST elevation or depression or T inversion).The presence of persistent ST elevation distinguishes STEMI from other forms of acute coronary syndrome.NSTEMI and unstable angina are distinguished by the presence or absence of a rise in cardiac injury markers[3-6].Fibrinolysis and percutaneous coronary intervention (PCI),are the definitive therapies for reperfusion in STEMI.These strategies have been on a frontline to improve patency of the infarct-related artery,reduce infarct size,and lower mortality rates.The time sensitivity nature of STEMI prompts for a quick implementation of one or the other of these two strategies[4-7].Surveys showed that many patients with STEMI from western countries remain “untreated” with limited access to reperfusion therapy and suboptimal utilization of proven pharmacotherapies in clinical practices.Up to one-third of patients presenting with STEMI within 12 h of symptom onset still receive no reperfusion therapy acutely,despite improvements in care[7-8].However,a recent study has shown that,80.9% of patients with STEMI in Beijing received reperfusion treatment (81% primary PCI; 19% thrombolysis).Meanwhile,the study implies that primary PCI was the predominant reperfusion strategy in Beijing[9].
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