PDF(Pubmed)
Abstract：
Since the introduction of the first pharmacological therapy for the treatment of patients with acute myocardial infarction in the early 20th century, treatment of myocardial infarction has evolved extensively throughout the years. Mechanical revascularization therapies such as the percutaneous transluminal coronary angioplasty, combined with the ongoing development of pharmacological therapies have successfully improved the survival of patients with acute myocardial infarction. To date, antiplatelet therapy (consisting of aspirin and an oral P2Y 12 inhibitor) and anticoagulation therapy represent the main stay of pharmacological treatment in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). The routine use of clopidogrel as antiplatelet agent has been largely replaced by the use of the more potent P2Y 12 inhibitors ticagrelor and prasugrel. Unfractionated heparin remains the preferred anticoagulant therapy, despite the development of other anticoagulants, including enoxaparin and bivalirudin. To date, limited evidence exists supporting a pre-hospital initiation of antiplatelet and anticoagulant therapy in STEMI patients. The use of potent intravenous antiplatelet agents, including the glycoprotein IIb/IIIa inhibitors and the intravenous P2Y 12 inhibitor cangrelor, is currently restricted to specific clinical settings. While several potent antithrombotic agents already exist, the search for novel potent antithrombotic agents continues, with a focus on balancing antithrombotic properties with an improved safety profile to reduce excess bleeding. This review provides an overview of currently available pharmacological therapies for the treatment of STEMI patients undergoing primary PCI, and an outlook for the ongoing development of novel agents in this field.
摘要：
自20世纪初推出第一种用于治疗急性心肌梗死患者的药物疗法以来，多年来，心肌梗塞的治疗已经广泛发展。机械血运重建治疗，如经皮腔内冠状动脉成形术，结合药物治疗的持续发展,已成功地提高了急性心肌梗死患者的生存率.迄今为止,在接受经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者中,抗血小板治疗(包括阿司匹林和口服P2Y12抑制剂)和抗凝治疗是药物治疗的主要选择.常规使用氯吡格雷作为抗血小板药物已被使用更有效的P2Y12抑制剂替格瑞洛和普拉格雷取代。普通肝素仍然是首选的抗凝疗法，尽管开发了其他抗凝剂，包括依诺肝素和比伐卢定.迄今为止,支持STEMI患者院前开始抗血小板和抗凝治疗的证据有限.使用强效静脉内抗血小板药物，包括糖蛋白IIb/IIIa抑制剂和静脉内P2Y12抑制剂坎格雷洛，目前仅限于特定的临床设置。虽然已经存在几种有效的抗血栓形成药物，寻找新型强效抗血栓药物的工作仍在继续，重点是平衡抗血栓形成特性和改善的安全性，以减少过度出血。这篇综述概述了目前可用于治疗接受原发性PCI的STEMI患者的药物疗法，并展望了该领域正在进行的新型药物的开发。
