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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 problem, even as the current diagnosis and management of acute myocardial infarction continue to improve. STEMI is a fatal event in about 33% of patients. STEMI is the only form of post-SARS that is the second most serious acute coronary syndrome (ACS). About 29% of patients with myocardial infarction experience STEMI (1), whereas 47% of patients with acute coronary syndrome (ACS) exhibit STEMI (2) symptoms. STEM is one of the three elements of coronary heart disease, the other two are unstable angina pectoris and non-ST-elevation myocardial infarction (NSTEMI), three constitute the elements of known coronary heart disease. Acute coronary syndrome is characterized by acute ischemic chest pain (rest or painful) associated with ischemic electrocardiographic changes (ST segment elevation or depression or T-reversal). The presence or absence of ST-segment elevation is another characteristic of STEMI distinguished from other forms of acute coronary disease. NSTEMI and unstable angina pectoris are distinguished by the presence or absence of markers of myocardial damage [3-6]. Fibrinolysis and percutaneous coronary intervention (PCI) and ultimately STEMI reperfusion therapy. These therapies are on the front line to improve infarct artery patency, reduce infarct size and reduce mortality. Time-sensitive STEMI requires the rapid implementation of one or both therapies [4-7]. Surveys show that STEMI patients in many Western countries have difficulty accessing reperfusion therapies and opting for clinically proven drug regimens that remain untreated until now. Up to one-third of patients with STEMI are still not receiving an emergency infusion within 12 hours of symptom onset, and although care is improving [7-8], a recent study showed that 80.9% of STEMI patients in Beijing received Perfusion therapy (81% for initial PCI; 19% for thrombolysis). At the same time, studies show that initial PCI is the main reperfusion therapy in Beijing patients [9]. This article aims to give two clear details of STEMI reperfusion therapy.