Examining treatment of ST-elevation myocardial infarction: the importance of early intervention.

Early reperfusion in ST-segment elevation myocardial infarction (STEMI) is imperative. Acute reperfusion may be achieved with fibrinolytic agents and/or percutaneous coronary intervention (PCI); however, PCI is associated with lower rates of death and myocardial infarction compared with fibrinolysis. As treatment delays are associated with worse outcomes, current guidelines recommend minimizing time from symptom onset to treatment initiation. Regardless of the reperfusion strategy, patients with STEMI are at increased risk of early recurrent ischemic events and death. These risks can be significantly reduced by promptly initiating a combination of pharmacotherapies that includes antiplatelet and anticoagulant agents, beta-blockers, and inhibitors of the renin-angiotensin-aldosterone system. This manuscript reviews the evidence supporting the most recent guidelines for STEMI management published jointly by the American College of Cardiology and American Heart Association. More recent evidence and its potential impact on future evidence-based guidelines are also addressed.