What is the treatment for ST-Elevation Myocardial Infarction (STEMI)?

From the Guidelines

The treatment for STEMI (ST-elevation myocardial infarction) should prioritize primary percutaneous coronary intervention (PCI) within 90 minutes of first medical contact, or fibrinolytic therapy if PCI is not feasible within 120 minutes, as recommended by the 2017 ESC guidelines 1. The goal of treatment is to restore blood flow to the heart muscle as quickly as possible to minimize damage.

• Key considerations in STEMI management include:
  • Reperfusion strategy selection: primary PCI is the preferred approach, but fibrinolysis should be initiated if the anticipated time to PCI-mediated reperfusion is > 120 minutes 1.
  • Antithrombotic therapy: anticoagulants and dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor (such as ticagrelor or prasugrel) are essential in the acute phase of STEMI 1.
  • Early care: patients should be monitored for at least 24 hours after reperfusion therapy, and early ambulation and discharge are recommended for uncomplicated patients 1.
• Additional medications that may be used in STEMI management include:
  • Beta-blockers (such as metoprolol) to reduce myocardial oxygen demand and improve survival 1.
  • ACE inhibitors or ARBs (such as lisinopril) to reduce mortality and morbidity in patients with STEMI 1.
  • High-intensity statins (such as atorvastatin) to reduce the risk of recurrent cardiovascular events 1.
• It is also important to note that patients with STEMI who present late or are ineligible for reperfusion therapy may still benefit from pharmacological nonlytic therapy, including antithrombotic and antiplatelet agents, as well as work-reducing therapies such as ACE inhibitors or ARBs 1.

From the FDA Drug Label

In patients with large ST segment elevation myocardial infarction, physicians should choose either thrombolysis or PCI as the primary treatment strategy for reperfusion Rescue PCI or subsequent elective PCI may be performed after administration of thrombolytic therapies if medically appropriate;

The treatment for STEMI is either thrombolysis or PCI (Percutaneous Coronary Intervention) as the primary treatment strategy for reperfusion.

• Thrombolysis can be performed using tenecteplase (TNKase).
• PCI can be performed as a rescue procedure after thrombolysis or as an elective procedure after thrombolytic therapy. 2 2

From the Research

Treatment for STEMI

The treatment for STEMI (ST-segment elevation myocardial infarction) typically involves a combination of antithrombotic therapy and primary percutaneous coronary intervention (PPCI).

• Antithrombotic therapy includes antiplatelet and anticoagulant agents to optimize clinical outcomes in patients with STEMI undergoing PPCI 3.
• The cornerstone of pharmacological treatment for STEMI patients undergoing PPCI is dual antiplatelet therapy with aspirin and an oral P2Y12-receptor inhibitor 3, 4.
• Prasugrel and ticagrelor are preferred over clopidogrel due to their more prompt, potent, and predictable antiplatelet effect, which translates into better clinical outcomes 3, 4.

Antithrombotic Therapy

Antithrombotic therapy for STEMI patients undergoing PPCI should take into account the variability of thrombotic and bleeding risk in the short and long term 5.

• Patients with STEMI profit from the administration of early onset antiplatelet agents and anticoagulation to achieve sufficient and predictable antithrombotic effect at the time of PPCI 5, 6.
• Antithrombotic therapies should be tailored to individual risk of recurrence over the long term, to avoid excess bleeding, while ensuring adequate secondary ischemic prevention 5.

Pre-Hospital Antiplatelet Therapy

Pre-hospital antiplatelet therapy is crucial in STEMI patients undergoing primary percutaneous coronary intervention 6.

• Early recanalization of the infarct-related artery to achieve myocardial reperfusion is the primary therapeutic goal in patients with STEMI 6.
• New parenteral drugs achieve immediate inhibition of platelet aggregation, and fast and easy methods of administration may create the opportunity to bridge the initial gap in platelet inhibition observed with oral P2Y12 inhibitors 6.

Adjunctive Antiplatelet Therapy

Adjunctive antiplatelet therapy is critically important to optimize the early treatment of STEMI 7.

• Aggressive antiplatelet therapy with clopidogrel reduces mortality in STEMI patients and offers significant clinical benefits, without an associated increase in major bleeding events 7.
• Glycoprotein IIb/IIIa inhibitors are generally not used with fibrinolytic agents in acute STEMI management, as they increase the risk of intracranial hemorrhage 7.