Kenntniskontrolle STEMI, Teil 1

Patients with a clinical suspicion of ongoing myocardial ischaemia and LBBB should be managed in a way similar to STEMI patients, regardless of whether the LBBB is previously known. It is important to remark that the presence of a (presumed) new LBBB does not predict an MI per se.⁵⁴

Likewise, ST-segment depression in leads V₁–V₃ suggests myocardial ischaemia, especially when the terminal T-wave is positive (ST-segment elevation equivalent), and confirmation by concomitant ST-segment elevation ≥ 0.5 mm recorded in leads V₇–V₉ should be considered as a means to identify posterior MI.⁸

In cases of symptom relief after nitroglycerin administration, another 12-lead ECG must be obtained. A complete normalization of the ST-segment elevation after nitroglycerin administration, along with complete relief of symptoms, is suggestive of coronary spasm, with or without associated MI. In these cases, an early coronary angiography (within 24 h) is recommended. In cases of recurrent episodes of ST-segment elevation or chest pain, immediate angiography is required.

Die Thrombus-Aspiration wurde herabgestuft.

Although ischaemic heart disease develops on average 7–10 years later in women compared with men, MI remains a leading cause of death in women. Acute coronary syndrome (ACS) occurs three to four times more often in men than in women below the age of 60 years, but after the age of 75, women represent the majority of patients.²⁶ Women tend to present more often with atypical symptoms, up to 30% in some registries,²⁷ and tend to present later than men.^28,29 It is therefore important to maintain a high degree of awareness for MI in women with potential symptoms of ischaemia. Women also have a higher risk of bleeding complications with PCI.

Nevertheless, mortality remains substantial; the in-hospital mortality of unselected patients with STEMI in the national registries of the ESC countries varies between 4 and 12%,²³ while reported 1-year mortality among STEMI patients in angiography registries is approximately 10%.^24,25

The mortality in STEMI patients is influenced by many factors, among them advanced age, Killip class, time delay to treatment, presence of emergency medical system (EMS)-based STEMI networks, treatment strategy, history of MI, diabetes mellitus, renal failure, number of diseased coronary arteries, and left ventricular ejection fraction (LVEF).

The term acute myocardial infarction (AMI) should be used when there is evidence of myocardial injury (defined as an elevation of cardiac troponin values with at least one value above the 99th percentile upper reference limit) with necrosis in a clinical setting consistent with myocardial ischaemia.