Acute coronary syndromes (ACS) include: sudden cardiac death (SCD), ST-segment elevation acute myocardial infarction (STEMI), non-ST-segment elevation acute myocardial infarction (NSTEMI), and unstable angina pectoris (UA).
Acute myocardial infarction (AMI): myocardial necrosis produced by acute stenosis or occlusion of coronary arteries, including STEMI and NSTEMI
1, AMI reperfusion therapy era faces challenges
(1) Myocardial non-perfusion after coronary artery opening has become a major problem
(2) Some patients with posterior organ enlargement and heart failure
(3) Intensive antithrombotic therapy serious bleeding complications appear
(4) The reduction of in-hospital morbidity and mortality rate varies greatly
(5) The three major causes of death in patients with AMI in the era of reperfusion therapy: cardiogenic shock (39%), cardiac rupture (21.8%), and PCI therapy-related death (28.2%) are obstacles to further reduction in the morbidity and mortality rate!
2. Causes of death of patients in the era of AMI reperfusion therapy
The causes of AMI deaths in the era of reperfusion therapy are listed in the following table
Table Causes and proportion of AMI deaths
Proportion of causes of AMI death
Causes of critical illness itself (67.3%)
Cardiogenic shock 39.1%
Mechanical complications
Cardiac rupture 21.8% VSD 3.6% Papillary muscle dissection 2.7% PCI treatment-related causes (28.2%) PCI operation-related causes 25.5% PCI drug-related causes 2.7% Comorbidity causes (4.5%)
Severe infection
1.8% Acute cerebral infarction 2.7%
Note: Data from the 2010 Beijing registry
3. Advantages of reperfusion therapy
The mortality rate of AMI depends on coronary blood flow and myocardial reperfusion, and the advantages of reperfusion therapy (RPT) are as follows.
(1) It can recanalize the acutely occluded coronary arteries and restore coronary blood flow and myocardial reperfusion.
(2) Rescuing the ischemic myocardium, reducing the infarct size, and improving hemodynamics.
(3) Protecting cardiac function, preventing ventricular enlargement and remodeling, and preventing the occurrence of heart failure.
(4) Reduces in-hospital mortality and improves long-term prognosis.
(5) is the most important emergency measure for STEMI, and the earlier it is started, the better; including: thrombolysis or emergency PCI; CABG: tried for left main stem occlusion that cannot be PCI, but the surgical risk is high.
Therefore, the sooner reperfusion therapy is started, the better, and it should be scrambled.
4, the main measures to prevent AMI myocardial no-reflow
(1) Distal protection and aspiration devices: to prevent microvascular embolism after coronary revascularization
(2) platelet IIa/IIIb receptor antagonists: antiplatelet prevention of microvascular thrombosis and embolism
(3) Vasodilators: focus on prevention of microvascular spasm