Pathophysiology and Its Clinical Medicine of Acute Myocardial Infarction in ST-Segment Elevation

doi:10.21127/yaoyimr20180016

Abstract

Abstract: Acute myocardial infarction (AMI) results from the acute occlusion of a coronary artery, most initiated by the rupture of a thin-cap fibro atheroma with subsequent formation of the occlusive thrombus at the rupture site. Its general symptom is chest pain with a sensation of tightness, pressure, or squeezing. AMI can be divided into NSTEMI and STEMI according to ECG. ST-segment elevation always accompanies with AMI in a severe mortality from 4% to 12%. European Society Of Cardiology (ESC) has recommended that percutaneous transluminal coronary intervention (PCI) is the preferred strategy to realize revascularization for STEMI patients, however, it is often hampered by incomplete microvascular myocardial reperfusion owing to distal embolization of thrombus. Time of door-to-balloon is another key limitation of rapid reperfusion. To address this problem, pharmacologic agents are increasingly used to emergent treat STEMI since their abilities to achieve rapid reperfusion within 12 h of symptom onset. According to the mechanism of thrombogenesis in the coronary artery, antiplatelet drugs and thrombolysis drugs have been widely applied in clinical therapy aiming to impede thrombosis and facilitating fibrinolysis. Antithrombotic drugs including aspirin, clopidogrel, prasugrel and ticagrelor have been successfully applied in clinical practice. Fibrinolytic drugs such as streptokinase (first-generation), tissue plasminogen activator (t-PA) and its recombinant forms (alteplase, reteplase as second-generation, and tenecteplase as third-generation) are also used to treat STEMI. However, side effects such as hematencephalon and non-specificity remains still to be solved. Expanding thrombolytic agents from biological sources for providing safety and efficacy for fibrinolytic drugs is a persistence goal for scientists. Several natural precursors with fibrinolytic function are step into the stage of clinical trials including alfimeprase, desmoteplase, lumbrokinase, etc. For the further study, high-specific thrombolytic agents with a longer plasma half-life to meet clinical needs are expected to be designed by combining the advantages of existing thrombolytic enzyme with molecular biology techniques. Restraining of plasminogen activator inhibitor-1 is another innovative hot-spot for developing fibrinolytic agent.

Key words: myocardial Infarction, ST elevation myocardial infarction, thrombolytic therapy, fibrinolytic drugs, thrombolytics

Ting Wang, Quan Shen, Bin Bao. Pathophysiology and Its Clinical Medicine of Acute Myocardial Infarction in ST-Segment Elevation[J]. Medicine Research, 2018, 2(4): 180016-.

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