Myocardial Infarction with and without ST-segment Elevation: a Contemporary Reappraisal of Similarities and Differences.
Myocardial Infarction with and without ST-segment Elevation: a Contemporary Reappraisal of Similarities and Differences.
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DOI：
10.2174/1573403x16999201210195702
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发表时间：
2021
影响因子：
1.9
通讯作者：
Gragnano F
中科院分区：
文献类型：
--
作者：
Mitsis A;Gragnano F
了解有无ST段抬高的心肌梗死的异同，是在目前的实践中正确处理患者的必要步骤。这两种综合征都是由冠状动脉的严重狭窄或完全闭塞(主要是由于动脉粥样硬化斑块上的血栓形成)引起的，都有相似的临床表现。最近的流行病学研究表明，ST段抬高心肌梗死(STEMI)和非ST段抬高心肌梗死(NSTEMI)的相对发病率呈相反趋势(分别减少和增加)，近期STEMI预后较差，但长期预后相似。目前的处理方法有所不同，对于STEMI，推荐立即再通，而对于NSTEMI，强制进行风险分层，以便对患者的风险进行分层，然后决定冠状动脉造影的时间。介入治疗的围术期和技术方面，以及抗血栓药物，在两种类型的MI中实施得最相似，在这两种情况下，常规的放射状通路、DES植入和新型的P2Y12抑制剂代表了护理的标准。下面的综述文章旨在比较两种类型的MI，有无持续性ST段抬高。主要目的是探索它们的异同，并解决在临床表现、治疗管理和预后方面的不确定领域。识别高风险的NSTEMI患者非常重要，因为他们可能需要一种个性化的方法，这种方法可能与目前STEMI的建议有很大重叠，如果他们的治疗延迟，他们的死亡率仍然很高。
Understanding the similarities and differences between myocardial infarction with or without ST-segment elevation is an essential step for proper patients’ management in current practice. Both syndromes are caused by critical stenosis or total occlusion of coronary arteries (mostly due to thrombosis on atherosclerotic plaque), and manifest with a similar clinical presentation. Recent epidemiologic studies show that the relative incidence of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) moves in an opposite fashion (decreasing and increasing respectively), with a prognosis that is worse at short-term follow-up for STEMI but comparable at long-term. Current management differs, as for STEMIs, immediate reperfusion is recommended, while for NSTEMIs, risk stratification is mandatory in order to stratify patients’ risk, and then decide the timing for coronary angiography. Periprocedural and technical aspects of the interventional management, as well as antithrombotic medications, are for the most similarly implemented in the two types of MI, with routine radial access, DES implant, and novel P2Y12 inhibitors representing the standard of care in both cases. The following review article aims to compare the two types of MI, with and without persistent ST-segment elevation. The main purpose is to explore their similarities and differences and address areas of uncertainty with regards to clinical presentation, therapeutic management, and prognosis. The identification of high-risk NSTEMI patients is important as they may require an individualised approach that can substantially overlap with current STEMI recommendations, and their mortality remains high if their management is delayed.