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🌱 來自: acute coronary syndromes
diagram of acute coronary syndromes
Figure: 
How are stenoses in nonculprit coronary arteries managed in patients undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI)?
Emergency reperfusion of ischemic myocardium that is in the process of becoming infarcted is the most important advance in the treatment of ST-segment elevation myocardial infarction (STEMI) over the past three decades and is the primary therapeutic goal. With broad application of reperfusion therapy for STEMI, 30-day mortality rates have progressively declined from more than 20% to less than 5%. Read the new review article on this topic.
Clinical Pearls
Q. Is oxygen supplementation beneficial in the initial management of patients with an acute coronary syndrome and normal oxygen levels?
A. The initial management of acute coronary syndromes includes bed rest with electrocardiogram monitoring and prompt initiation of antithrombotic therapy. Although the routine use of oxygen supplementation is still widespread, current evidence does not support its benefit in patients with normal oxygen levels. Hence, its use is recommended only for patients with hypoxemia (oxygen saturation <90%), respiratory distress, or other risk factors for hypoxemia.
Q. Use of which artery has been advocated for vascular access in patients undergoing percutaneous coronary intervention (PCI)?
A. In response to adverse outcomes associated with bleeding complications of PCI, radial-artery access has been advocated for coronary angiography and PCI, particularly for patients with STEMI, in whom bleeding at the access site is most common. The most recent and largest trial randomly assigned 8404 patients with either STEMI or non-STEMI to radial or femoral access. Radial access was associated with a reduction in the rate of adverse clinical events at 30 days, driven by decreases in deaths and major bleeding events, and was beneficial for both types of acute myocardial infarction. One challenge to rapid adoption of the radial approach in general practice is overcoming the learning curve for achieving the outcomes observed in clinical trials.