Acute ST-elevation myocardial infarction

Acute ST-elevation myocardial infarction (STEMI) remains the leading cause of death in industrialized countries. For many patients, a myocardial infarction is the first presentation of atherosclerotic coronary artery disease. This often results in delays in obtaining medical attention and subsequently poorer outcome, certainly because symptoms are often misinterpreted. Furthermore, a large proportion of STEMI patients die from lethal arrhythmias even before reaching medical facilities. Numerous studies during the past decades have firmly established the paradigm of achieving early, complete and sustained infarct-related artery patency. Because of a more aggressive therapy and rapid revascularization using either fibrinolysis or primary PCI, many patients do remarkably well after STEMI. Unfortunately, adherence to treatment guidelines is often suboptimal, leading to less favourable outcome. Also, more efficient care for patients with myocardial infarction has led to a rapidly growing population of patients with chronic heart failure.