Assessment and management of acute coronary syndromes (ACS): a Canadian perspective on current guideline-recommended treatment--part 2: ST-segment elevation myocardial infarction

Acute ST-segment elevation myocardial infarction (STEMI) accounts for approximately 30% of all acute coronary syndromes (ACS). The high early mortality for patients with STEMI is largely due to the extent of the ischemic injury. However, immediate reperfusion either pharmacologically with fibrinolysis or mechanically by primary percutaneous coronary intervention (PCI) limits the size of the infarction and reduces mortality. Reperfusion therapy by primary PCI reduces mortality and the risk of reinfarction, beyond the benefits achieved by fibrinolysis, especially when the primary PCI is initiated within 90 minutes of first medical contact. The use of adjuvant therapy with antiplatelet and anticoagulant agents is essential to enhance the results of reperfusion, and/or maintain vessel patency following either mode of reperfusion. This review discusses the assessment and management of the patient with an acute STEMI, using recommendations from the most recent American College of Cardiology/American Heart Association, European Society of Cardiology, and existing Canadian guidelines. It provides an updated perspective and critical appraisal with practical application of the recommendations within the Canadian Healthcare system.