New data on early management of patients with ST-elevation myocardial infarction.

The advances in the early treatment of ST-segment elevation acute myocardial infarction have resulted in a significant reduction in mortality. Early pharmacologic therapy with antiplatelet and antithrombotic therapy coupled with rapid and complete mechanical or pharmacologic reperfusion has been shown to reduce infarct size, improve left ventricular function, and reduce morbidity and mortality. Primary angioplasty, if done by an experienced team in a timely manner, has been found to be superior to fibrinolytic therapy and superior to facilitated angioplasty. The American College of Cardiology/American Heart Association guidelines recommend the goal of a door-to-balloon time of less than 90 minutes. National efforts to reduce delays and to improve access to timely therapy will significantly reduce mortality even further.