Management of ST-elevation myocardial infarction

Ischaemic heart disease, and myocardial infarction (MI) in particular, remains a common cause of morbidity and mortality worldwide. Acute ST-elevation MI (STEMI) usually results from occlusive thrombus formation following coronary plaque rupture. Immediate measures, such as the administration of aspirin and early defibrillation, can be lifesaving in STEMI. Prompt and appropriate reperfusion therapy plays a major role in improving short-term and long-term STEMI outcome. Primary percutaneous coronary intervention (PPCI) is superior to thrombolytic therapy and is the current 'gold standard' reperfusion strategy. Adjunctive reperfusion therapy includes anti-platelet drugs and anticoagulation, the specific agents used differing according to reperfusion method. Early reperfusion therapy together with aggressive secondary prevention and lifestyle modification has led to a significant reduction in STEMI-related mortality.