Current antithrombotic management of ST elevation acute coronary syndromes in the Cath lab - A paradigm shift

摘要

The management of ST elevation myocardial infarction (STEMI) has nowadays reached a very high level of quality, warranting a high improvement in medium-term and long-term survival. Since the introduction of primary percutaneous coronary interventions (PCI) for the immediate management of this emergency, 1-month mortality in high volume centres was cut to 2-3%; this percentage is slightly higher in an all-comers population (5-8%). One of the main reasons for this spectacular improvement is strictly linked to some recent developments in the field of antithrombotic drugs, and the widespread use of thrombectomy. Gly-coprotein IIb/IIIa inhibitors have gained a precise role during primary PCI, especially in case of high thrombotic burden. However, an increased risk of bleeding has been often described, especially with older patients and with those suffering other co-morbidities. But the cardiologist devoted to coronary interventions has many different options nowadays, including potent oral antiplatelet agents and the intravenous direct thrombin inhibitor bivalirudin.