Skip to main content
SpringerLink
Log in

Therapy in ST-elevation myocardial infarction: reperfusion strategies, pharmacology and stent selection

  • Coronary Artery Disease (D Feldman, Section Editor)
  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

The estimated annual incidence of new and recurrent myocardial infarction (MI) in the U.S. is 715,000 events. Primary percutaneous coronary intervention (PCI) is the reperfusion strategy of choice in most patients with acute ST-elevation myocardial infarction (STEMI). Recent advances in percutaneous techniques and devices, including manual aspiration catheters and newer generation drug eluting stents and pharmacologic therapies, such as novel antiplatelets and anticoagulants have led to significant improvements in the acute and long-term outcomes for these patients. Implementation of community-wide systems directed to shorten treatment times tied to closely monitored quality improvement processes have led to further advances in STEMI care. Recent data suggests that transradial access for primary PCI is associated with improved outcomes. This contemporary review discusses the strategies for reperfusion, pharmacological therapy and stent selection process involved in STEMI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population trends in the incidence and outcomes of acute myocardial infarction. N Engl J Med. 2010;362(23):2155–65.

    Article  PubMed  CAS  Google Scholar 

  2. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation. 2013;127(1):e6–245.

    Article  PubMed  Google Scholar 

  3. Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med. 2013;369(10):901–9. Important landmark article that demonstrates no further reductions in mortality with decreasing door to balloon times.

    Google Scholar 

  4. Anderson JL, Karagounis LA, Califf RM. Metaanalysis of five reported studies on the relation of early coronary patency grades with mortality and outcomes after acute myocardial infarction. Am J Cardiol. 1996;78(1):1–8.

    Article  PubMed  CAS  Google Scholar 

  5. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. Lancet. Feb 5 1994;343(8893):311-322.

  6. O'Neill W, Timmis GC, Bourdillon PD, et al. A prospective randomized clinical trial of intracoronary streptokinase versus coronary angioplasty for acute myocardial infarction. N Engl J Med. 1986;314(13):812–8.

    Article  PubMed  Google Scholar 

  7. Ribeiro EE, Silva LA, Carneiro R, et al. Randomized trial of direct coronary angioplasty versus intravenous streptokinase in acute myocardial infarction. J Am Coll Cardiol. 1993;22(2):376–80.

    Article  PubMed  CAS  Google Scholar 

  8. Zijlstra F, Beukema WP, van’t Hof AW, et al. Randomized comparison of primary coronary angioplasty with thrombolytic therapy in low risk patients with acute myocardial infarction. J Am Coll Cardiol. 1997;29(5):908–12.

    Article  PubMed  CAS  Google Scholar 

  9. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361(9351):13–20.

    Article  PubMed  Google Scholar 

  10. Armstrong PW, Gershlick AH, Goldstein P, et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013;368(15):1379–87. Important randomized clinical trial.

    Google Scholar 

  11. McGinn AP, Rosamond WD, Goff Jr DC, Taylor HA, Miles JS, Chambless L. Trends in prehospital delay time and use of emergency medical services for acute myocardial infarction: experience in 4 US communities from 1987-2000. Am Heart J. 2005;150(3):392–400.

    Article  PubMed  Google Scholar 

  12. Le May MR, So DY, Dionne R, et al. A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2008;358(3):231–40.

    Article  PubMed  Google Scholar 

  13. O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362–425. Most recent ACC/AHA STEMI guidelines.

    Google Scholar 

  14. Steg PG, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–619. Most recent ESC STEMI guidelines.

    Google Scholar 

  15. Andersen HR, Nielsen TT, Vesterlund T, et al. Danish multicenter randomized study on fibrinolytic therapy versus acute coronary angioplasty in acute myocardial infarction: rationale and design of the DANish trial in Acute Myocardial Infarction-2 (DANAMI-2). Am Heart J. 2003;146(2):234–41.

    Article  PubMed  CAS  Google Scholar 

  16. Nielsen PH, Terkelsen CJ, Nielsen TT, et al. System delay and timing of intervention in acute myocardial infarction (from the Danish Acute Myocardial Infarction-2 [DANAMI-2] trial). Am J Cardiol. 2011;108(6):776–81.

    Article  PubMed  Google Scholar 

  17. McNamara RL, Herrin J, Wang Y, et al. Impact of delay in door-to-needle time on mortality in patients with ST-segment elevation myocardial infarction. Am J Cardiol. 2007;100(8):1227–32.

    Article  PubMed Central  PubMed  Google Scholar 

  18. Chareonthaitawee P, Gibbons RJ, Roberts RS, Christian TF, Burns R, Yusuf S. The impact of time to thrombolytic treatment on outcome in patients with acute myocardial infarction. For the CORE investigators (Collaborative Organisation for RheothRx Evaluation). Heart. 2000;84(2):142–8.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  19. Gersh BJ, Stone GW, White HD, Holmes Jr DR. Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardial infarction: is the slope of the curve the shape of the future? JAMA. 2005;293(8):979–86.

  20. Thune JJ, Hoefsten DE, Lindholm MG, et al. Simple risk stratification at admission to identify patients with reduced mortality from primary angioplasty. Circulation. 2005;112(13):2017–21.

    Article  PubMed  Google Scholar 

  21. Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk score for ST-elevation myocardial infarction: A convenient, bedside, clinical score for risk assessment at presentation: An intravenous nPA for treatment of infarcting myocardium early II trial substudy. Circulation. 2000;102(17):2031–7.

    Article  PubMed  CAS  Google Scholar 

  22. Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet. 1996;348(9030):771–5.

    Article  PubMed  CAS  Google Scholar 

  23. Bonnefoy E, Steg PG, Boutitie F, et al. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J. 2009;30(13):1598–606.

    Article  PubMed  Google Scholar 

  24. Nallamothu BK, Bates ER. Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? Am J Cardiol. 2003;92(7):824–6.

    Article  PubMed  Google Scholar 

  25. Pinto DS, Kirtane AJ, Nallamothu BK, et al. Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation. 2006;114(19):2019–25.

    Article  PubMed  Google Scholar 

  26. Wang TY, Nallamothu BK, Krumholz HM, et al. Association of door-in to door-out time with reperfusion delays and outcomes among patients transferred for primary percutaneous coronary intervention. JAMA. 2011;305(24):2540–7. Important observational study highlighting the importance of prompt triage of STEMI patients in facilities without PCI.

    Google Scholar 

  27. Pinto DS, Frederick PD, Chakrabarti AK, et al. Benefit of transferring ST-segment-elevation myocardial infarction patients for percutaneous coronary intervention compared with administration of onsite fibrinolytic declines as delays increase. Circulation. 2011;124(23):2512–21. Important observational study indicating the importance indicating that PCI is preferrable to fibrinolytic therapy in facilities without onsite PCI, in particularly when delays to presentation are longer.

    Google Scholar 

  28. Schroder R, Wegscheider K, Schroder K, Dissmann R, Meyer-Sabellek W. Extent of early ST segment elevation resolution: a strong predictor of outcome in patients with acute myocardial infarction and a sensitive measure to compare thrombolytic regimens. A substudy of the International Joint Efficacy Comparison of Thrombolytics (INJECT) trial. J Am Coll Cardiol. 1995;26(7):1657–64.

    Article  PubMed  CAS  Google Scholar 

  29. Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, et al. Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials. J Am Coll Cardiol. 2007;49(4):422–30.

    Article  PubMed  Google Scholar 

  30. Gershlick AH, Stephens-Lloyd A, Hughes S, et al. Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med. 2005;353(26):2758–68.

    Article  PubMed  CAS  Google Scholar 

  31. Hochman JS, Sleeper LA, White HD, et al. One-year survival following early revascularization for cardiogenic shock. JAMA. 2001;285(2):190–2.

    Google Scholar 

  32. Ohman EM, Califf RM, Topol EJ, et al. Consequences of reocclusion after successful reperfusion therapy in acute myocardial infarction. TAMI Study Group. Circulation. 1990;82(3):781–91.

    Article  PubMed  CAS  Google Scholar 

  33. Nijland F, Kamp O, Verheugt FW, Veen G, Visser CA. Long-term implications of reocclusion on left ventricular size and function after successful thrombolysis for first anterior myocardial infarction. Circulation. 1997;95(1):111–7.

    Article  PubMed  CAS  Google Scholar 

  34. Borgia F, Goodman SG, Halvorsen S, et al. Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis. Eur Heart J. 2010;31(17):2156–69.

    Article  PubMed  Google Scholar 

  35. Cantor WJ, Fitchett D, Borgundvaag B, et al. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med. 2009;360(26):2705–18.

    Article  PubMed  Google Scholar 

  36. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet. Feb 18 2006;367(9510):569-578.

  37. Svilaas T, Vlaar PJ, van der Horst IC, et al. Thrombus aspiration during primary percutaneous coronary intervention. N Engl J Med. 2008;358(6):557–67.

    Article  PubMed  CAS  Google Scholar 

  38. Vlaar PJ, Svilaas T, van der Horst IC, et al. Cardiac death and reinfarction after 1 year in the Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS): a 1-year follow-up study. Lancet. 2008;371(9628):1915–20.

    Article  PubMed  Google Scholar 

  39. Stone GW, Maehara A, Witzenbichler B, et al. Intracoronary abciximab and aspiration thrombectomy in patients with large anterior myocardial infarction: the INFUSE-AMI randomized trial. JAMA. 2012;307(17):1817–26. 2x2 factorial design randomized clinical trial showing no benefit of intracoronary abciximab or thrombus aspiration during primary PCI.

    Google Scholar 

  40. Frobert O, Lagerqvist B, Olivecrona GK, et al. Thrombus Aspiration during ST-Segment Elevation Myocardial Infarction. N Engl J Med. 2013;369(17):1587–97. Important randomized clinical trial showing the benefit of thrombus aspiration during primary PCI.

    Google Scholar 

  41. Jolly SS, Cairns J, Yusuf S, et al. Design and rationale of the TOTAL trial: a randomized trial of routine aspiration ThrOmbecTomy with percutaneous coronary intervention (PCI) versus PCI ALone in patients with ST elevation myocardial infarction undergoing primary PCI. Am Heart J 2013. In press.

  42. Muller DW, Topol EJ, Ellis SG, Sigmon KN, Lee K, Califf RM. Multivessel coronary artery disease: a key predictor of short-term prognosis after reperfusion therapy for acute myocardial infarction. Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group. Am Heart J. 1991;121(4 Pt 1):1042–9.

    Article  PubMed  CAS  Google Scholar 

  43. Jaski BE, Cohen JD, Trausch J, et al. Outcome of urgent percutaneous transluminal coronary angioplasty in acute myocardial infarction: comparison of single-vessel versus multivessel coronary artery disease. Am Heart J. 1992;124(6):1427–33.

    Article  PubMed  CAS  Google Scholar 

  44. Vlaar PJ, Mahmoud KD, Holmes Jr DR, et al. Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: a pairwise and network meta-analysis. J Am Coll Cardiol. 2011;58(7):692–703.

    Article  PubMed  Google Scholar 

  45. Wald DS, Morris JK, Wald NJ, et al. Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med. 2013;369(12):1115–23. First study to suggest advantage of non-culprit vessel PCI in STEMI.

    Google Scholar 

  46. Agostoni P, Biondi-Zoccai GG, de Benedictis ML, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol. 2004;44(2):349–56.

    Article  PubMed  Google Scholar 

  47. Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet. 2011;377(9775):1409–20.

    Article  PubMed  Google Scholar 

  48. Mehta SR, Jolly SS, Cairns J, et al. Effects of radial versus femoral artery access in patients with acute coronary syndromes with or without ST-segment elevation. J Am Coll Cardiol. 2012;60(24):2490–9. Important subgroup analysis of the RIVAL trial demonstrating decreased mortality with use of transradial access for primary PCI.

    Google Scholar 

  49. Romagnoli E, Biondi-Zoccai G, Sciahbasi A, et al. Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study. J Am Coll Cardiol. 2012;60(24):2481–9. Randomized study demonstrated decreased mortality with transradial access for PCI in a broad population of patients with ST-elevation acute coronary syndromes.

    Google Scholar 

  50. Baklanov DV, Kaltenbach LA, Marso SP, et al. The prevalence and outcomes of transradial percutaneous coronary intervention for ST-segment elevation myocardial infarction: analysis from the National Cardiovascular Data Registry (2007 to 2011). J Am Coll Cardiol. 2013;61(4):420–6. Large observational study demonstrating improved outcomes with transradial access in patients with STEMI.

    Google Scholar 

  51. Jang JS, Jin HY, Seo JS, et al. The transradial versus the transfemoral approach for primary percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis. EuroIntervention: J EuroPCR Collab Work Group Interv Cardiol Eur Soc Cardiol. 2012;8(4):501–10.

    Article  Google Scholar 

  52. Rao SV, Ou FS, Wang TY, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2008;1(4):379–86.

    Article  PubMed  Google Scholar 

  53. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators. The New England journal of medicine. Sep 2 1993;329(10):673-682.

  54. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico (GISSI). Lancet. Feb 22 1986;1(8478):397-402.

  55. Van De Werf F, Adgey J, Ardissino D, et al. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet. 1999;354(9180):716–22.

    Article  Google Scholar 

  56. Mehta SR, Bassand JP, Chrolavicius S, et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med. 2010;363(10):930–42.

    Article  PubMed  Google Scholar 

  57. Foster CJ, Prosser DM, Agans JM, et al. Molecular identification and characterization of the platelet ADP receptor targeted by thienopyridine antithrombotic drugs. J Clin Investig. 2001;107(12):1591–8.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  58. Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. New Engl J Med. 2005;352(12):1179–89.

    Article  PubMed  CAS  Google Scholar 

  59. Chen ZM, Jiang LX, Chen YP, et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005;366(9497):1607–21.

    Article  PubMed  CAS  Google Scholar 

  60. Jolly SS, Pogue J, Haladyn K, et al. Effects of aspirin dose on ischaemic events and bleeding after percutaneous coronary intervention: insights from the PCI-CURE study. Eur Heart J. 2009;30(8):900–7.

    Article  PubMed  CAS  Google Scholar 

  61. Mehta SR, Tanguay JF, Eikelboom JW, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet. 2010;376(9748):1233–43.

    Article  PubMed  CAS  Google Scholar 

  62. Roe MT, Armstrong PW, Fox KA, et al. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med. 2012;367(14):1297–309.

    Article  PubMed  CAS  Google Scholar 

  63. Steg PG, James S, Harrington RA, et al. Ticagrelor versus clopidogrel in patients with ST-elevation acute coronary syndromes intended for reperfusion with primary percutaneous coronary intervention: A Platelet Inhibition and Patient Outcomes (PLATO) trial subgroup analysis. Circulation. 2010;122(21):2131–41.

    Article  PubMed  Google Scholar 

  64. Montalescot G, Wiviott SD, Braunwald E, et al. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet. 2009;373(9665):723–31.

    Article  PubMed  CAS  Google Scholar 

  65. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57.

    Article  PubMed  CAS  Google Scholar 

  66. Montalescot G, Barragan P, Wittenberg O, et al. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med. 2001;344(25):1895–903.

    Article  PubMed  CAS  Google Scholar 

  67. Stone GW, Grines CL, Cox DA, et al. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med. 2002;346(13):957–66.

    Article  PubMed  CAS  Google Scholar 

  68. Tcheng JE, Kandzari DE, Grines CL, et al. Benefits and risks of abciximab use in primary angioplasty for acute myocardial infarction: the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial. Circulation. 2003;108(11):1316–23.

    Article  PubMed  CAS  Google Scholar 

  69. ten Berg JM. van 't Hof AW, Dill T, et al. Effect of early, pre-hospital initiation of high bolus dose tirofiban in patients with ST-segment elevation myocardial infarction on short- and long-term clinical outcome. J Am Coll Cardiol. 2010;55(22):2446–55.

    Article  PubMed  Google Scholar 

  70. Mehilli J, Kastrati A, Schulz S, et al. Abciximab in patients with acute ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention after clopidogrel loading: a randomized double-blind trial. Circulation. 2009;119(14):1933–40.

    Article  PubMed  CAS  Google Scholar 

  71. De Luca G, Bellandi F, Huber K, et al. Early glycoprotein IIb-IIIa inhibitors in primary angioplasty-abciximab long-term results (EGYPT-ALT) cooperation: individual patient's data meta-analysis. J Thromb Haemost: JTH. 2011;9(12):2361–70.

    Article  Google Scholar 

  72. Thiele H, Wohrle J, Hambrecht R, et al. Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial. Lancet. 2012;379(9819):923–31.

    Article  PubMed  CAS  Google Scholar 

  73. Stone GW, Witzenbichler B, Guagliumi G, et al. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med. 2008;358(21):2218–30.

    Article  PubMed  CAS  Google Scholar 

  74. Stone GW, Witzenbichler B, Guagliumi G, et al. Heparin plus a glycoprotein IIb/IIIa inhibitor versus bivalirudin monotherapy and paclitaxel-eluting stents versus bare-metal stents in acute myocardial infarction (HORIZONS-AMI): final 3-year results from a multicentre, randomised controlled trial. Lancet. 2011;377(9784):2193–204.

    Article  PubMed  CAS  Google Scholar 

  75. Roe MT, Messenger JC, Weintraub WS, et al. Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. J Am Coll Cardiol. 2010;56(4):254–63.

    Article  PubMed  Google Scholar 

  76. Antman EM, Morrow DA, McCabe CH, et al. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med. 2006;354(14):1477–88.

    Article  PubMed  CAS  Google Scholar 

  77. Murphy SA, Gibson CM, Morrow DA, et al. Efficacy and safety of the low-molecular weight heparin enoxaparin compared with unfractionated heparin across the acute coronary syndrome spectrum: a meta-analysis. Eur Heart J. 2007;28(17):2077–86.

    Article  PubMed  CAS  Google Scholar 

  78. White H. Thrombin-specific anticoagulation with bivalirudin versus heparin in patients receiving fibrinolytic therapy for acute myocardial infarction: the HERO-2 randomised trial. Lancet. 2001;358(9296):1855–63.

    Article  PubMed  CAS  Google Scholar 

  79. Yusuf S, Mehta SR, Chrolavicius S, et al. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA. 2006;295(13):1519–30.

    Article  PubMed  CAS  Google Scholar 

  80. Montalescot G, Zeymer U, Silvain J, et al. Intravenous enoxaparin or unfractionated heparin in primary percutaneous coronary intervention for ST-elevation myocardial infarction: the international randomised open-label ATOLL trial. Lancet. 2011;378(9792):693–703.

    Article  PubMed  CAS  Google Scholar 

  81. Navarese EP, De Luca G, Castriota F, et al. Low-molecular-weight heparins vs. unfractionated heparin in the setting of percutaneous coronary intervention for ST-elevation myocardial infarction: a meta-analysis. J Thromb Haemost: JTH. 2011;9(10):1902–15.

    Article  PubMed  CAS  Google Scholar 

  82. Silvain J, Beygui F, Barthelemy O, et al. Efficacy and safety of enoxaparin versus unfractionated heparin during percutaneous coronary intervention: systematic review and meta-analysis. BMJ. 2012;344:e553.

    Article  PubMed Central  PubMed  Google Scholar 

  83. Grines CL, Cox DA, Stone GW, et al. Coronary angioplasty with or without stent implantation for acute myocardial infarction. Stent Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med. 1999;341(26):1949–56.

    Article  PubMed  CAS  Google Scholar 

  84. Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Lancet. 1998;352(9122):87-92.

  85. De Luca G, Suryapranata H, Stone GW, et al. Coronary stenting versus balloon angioplasty for acute myocardial infarction: a meta-regression analysis of randomized trials. Int J Cardiol. 2008;126(1):37–44.

    Article  PubMed  Google Scholar 

  86. Nordmann AJ, Hengstler P, Harr T, Young J, Bucher HC. Clinical outcomes of primary stenting versus balloon angioplasty in patients with myocardial infarction: a meta-analysis of randomized controlled trials. Am J Med. 2004;116(4):253–62.

    Article  PubMed  Google Scholar 

  87. Gibson CM, Karha J, Murphy SA, et al. Early and long-term clinical outcomes associated with reinfarction following fibrinolytic administration in the Thrombolysis in Myocardial Infarction trials. J Am Coll Cardiol. 2003;42(1):7–16.

    Article  PubMed  Google Scholar 

  88. Camenzind E SP, Wijns W. A meta-analysis of first generation drug eluting stent programs. Program and Abstracts from the World Congress of Cardiology 2006, Barcelona, September 2-5, 2006. Hotline Session I.

  89. Nordmann AJ BM, Bucher HC. Safety of drug-eluting stents: insights from a meta-analysis. Program and Abstracts from the World Congress of Cardiology 2006, Barcelona, September 2-5, 2006. Hotline Session I.

  90. Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalescot G. Drug eluting stents: an updated meta-analysis of randomised controlled trials. Heart. 2006;92(5):641–9.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  91. Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350(3):221–31.

    Article  PubMed  CAS  Google Scholar 

  92. Daemen J, Tanimoto S, Garcia-Garcia HM, et al. Comparison of three-year clinical outcome of sirolimus- and paclitaxel-eluting stents versus bare metal stents in patients with ST-segment elevation myocardial infarction (from the RESEARCH and T-SEARCH Registries). Am J Cardiol. 2007;99(8):1027–32.

    Article  PubMed  CAS  Google Scholar 

  93. Spertus JA, Kettelkamp R, Vance C, et al. Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation. 2006;113(24):2803–9.

    Article  PubMed  CAS  Google Scholar 

  94. Raber L, Wohlwend L, Wigger M, et al. Five-year clinical and angiographic outcomes of a randomized comparison of sirolimus-eluting and paclitaxel-eluting stents: results of the Sirolimus-Eluting Versus Paclitaxel-Eluting Stents for Coronary Revascularization LATE trial. Circulation. Jun 21 2011;123(24):2819-2828, 2816 p following 2828.

    Google Scholar 

  95. Dirksen MT, Vink MA, Suttorp MJ, et al. Two year follow-up after primary PCI with a paclitaxel-eluting stent versus a bare-metal stent for acute ST-elevation myocardial infarction (the PASSION trial): a follow-up study. EuroIntervention: J EuroPCR Collab Work Group Interv Cardiol Eur Soc Cardiol. 2008;4(1):64–70.

    Article  Google Scholar 

  96. Spaulding C, Teiger E, Commeau P, et al. Four-year follow-up of TYPHOON (trial to assess the use of the CYPHer sirolimus-eluting coronary stent in acute myocardial infarction treated with BallOON angioplasty). JACC Cardiovasc Interv. 2011;4(1):14–23.

    Article  PubMed  Google Scholar 

  97. Dangas GD, Caixeta A, Mehran R, et al. Frequency and predictors of stent thrombosis after percutaneous coronary intervention in acute myocardial infarction. Circulation. 2011;123(16):1745–56.

    Article  PubMed  Google Scholar 

  98. De Luca G, Dirksen MT, Spaulding C, et al. Drug-eluting vs bare-metal stents in primary angioplasty: a pooled patient-level meta-analysis of randomized trials. Arch Intern Med. 2012;172(8):611–21.

    Article  PubMed  Google Scholar 

  99. Mauri L, Silbaugh TS, Garg P, et al. Drug-eluting or bare-metal stents for acute myocardial infarction. N Engl J Med. 2008;359(13):1330–42.

    Article  PubMed  CAS  Google Scholar 

  100. Obata JE, Kitta Y, Takano H, et al. Sirolimus-eluting stent implantation aggravates endothelial vasomotor dysfunction in the infarct-related coronary artery in patients with acute myocardial infarction. J Am Coll Cardiol. 2007;50(14):1305–9.

    Article  PubMed  CAS  Google Scholar 

  101. Togni M, Raber L, Cocchia R, et al. Local vascular dysfunction after coronary paclitaxel-eluting stent implantation. Int J Cardiol. 2007;120(2):212–20.

    Article  PubMed  Google Scholar 

  102. Garg S, Serruys PW. Coronary stents: looking forward. J Am Coll Cardiol. 2010;56(10 Suppl):S43–78.

    Article  PubMed  CAS  Google Scholar 

  103. Sammel AM, Chen D, Jepson N. New generation coronary stent technology–is the future biodegradable? Heart Lung Circ. 2013;22(7):495–506.

    Article  PubMed  Google Scholar 

  104. Park DW, Kim YH, Yun SC, et al. Comparison of zotarolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for coronary revascularization: the ZEST (comparison of the efficacy and safety of zotarolimus-eluting stent with sirolimus-eluting and paclitaxel-eluting stent for coronary lesions) randomized trial. J Am Coll Cardiol. 2010;56(15):1187–95.

    Article  PubMed  Google Scholar 

  105. Lee CW, Park DW, Lee SH, et al. Comparison of the efficacy and safety of zotarolimus-, sirolimus-, and paclitaxel-eluting stents in patients with ST-elevation myocardial infarction. Am J Cardiol. 2009;104(10):1370–6.

    Article  PubMed  CAS  Google Scholar 

  106. de Waha A, Cassese S, Park DW, et al. Everolimus-eluting versus sirolimus-eluting stents: an updated meta-analysis of randomized trials. Clin Res Cardiol Off J German Cardiac Soc. 2012;101(6):461–7.

    Article  CAS  Google Scholar 

  107. Raber L, Magro M, Stefanini GG, et al. Very late coronary stent thrombosis of a newer-generation everolimus-eluting stent compared with early-generation drug-eluting stents: a prospective cohort study. Circulation. 2012;125(9):1110–21.

    Article  PubMed  Google Scholar 

  108. Palmerini T, Biondi-Zoccai G, Della Riva D, et al. Stent thrombosis with drug-eluting and bare-metal stents: evidence from a comprehensive network meta-analysis. Lancet. 2012;379(9824):1393–402.

    Article  PubMed  CAS  Google Scholar 

  109. Kimura T, Morimoto T, Kozuma K, et al. Comparisons of baseline demographics, clinical presentation, and long-term outcome among patients with early, late, and very late stent thrombosis of sirolimus-eluting stents: Observations from the Registry of Stent Thrombosis for Review and Reevaluation (RESTART). Circulation. 2010;122(1):52–61.

    Article  PubMed  Google Scholar 

  110. Navarese EP, Kubica J, Castriota F, et al. Safety and efficacy of biodegradable vs. durable polymer drug-eluting stents: evidence from a meta-analysis of randomised trials. EuroIntervention: J EuroPCR Collab Work Group Interv Cardiol Eur Soc Cardiol. 2011;7(8):985–94.

    Article  Google Scholar 

  111. Koch KT on Behalf of APPOSITION III Investigators. A post- market study to assess the STENTYS self-expanding coronary stent in acute myocardial infarction in real life. TCT San Francisco, USA 2011.

  112. Stentys Coronary Stent System Clinical Trial in Patients With Acute Myocardial Infarction (APPOSITION V). http://clinicaltrials.gov/show/NCT01732341.

  113. Park DW, Park SW, Park KH, et al. Frequency of and risk factors for stent thrombosis after drug-eluting stent implantation during long-term follow-up. Am J Cardiol. 2006;98(3):352–6.

    Article  PubMed  Google Scholar 

  114. Pfisterer M, Brunner-La Rocca HP, Buser PT, et al. Late clinical events after clopidogrel discontinuation may limit the benefit of drug-eluting stents: an observational study of drug-eluting versus bare-metal stents. J Am Coll Cardiol. 2006;48(12):2584–91.

    Article  PubMed  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Dr. Vikas Singh and Dr. Mauricio G. Cohen each declare no potential conflicts of interest relevant to this article.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Cardiovascular Division, and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital, Miller School of Medicine, 1400 N.W. 12th Avenue, Suite 1179, Miami, FL, 33136, USA

    Vikas Singh MD & Mauricio G. Cohen MD

Authors
  1. Vikas Singh MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mauricio G. Cohen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mauricio G. Cohen MD.

Additional information

This article is part of the Topical Collection on Coronary Artery Disease

Rights and permissions

Reprints and permissions

About this article

Cite this article

Singh, V., Cohen, M.G. Therapy in ST-elevation myocardial infarction: reperfusion strategies, pharmacology and stent selection. Curr Treat Options Cardio Med 16, 302 (2014). https://doi.org/10.1007/s11936-014-0302-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11936-014-0302-9

Keywords

Search

Navigation