Kommentar zu den Leitlinien der Europäischen Gesellschaft für Kardiologie (ESC) zur Therapie des akuten Herzinfarkts bei Patienten mit ST-Streckenhebung (STEMI)

In August 2012 amended guidelines of the European Society of Cardiology on the acute therapy patients with persisting ST segment elevation myocardial infarction (STEMI) were published to replace the guidelines from the year 2008. The major changes affect patients with atypical electrocardiogram (ECG) alterations with signs and symptoms of persistent ischemia who need rapid treatment. The treatment of patients with cardiac arrest has for the first time been given a chapter on its own with emphasis on the necessity for immediate invasive diagnostics. The chapter on logistics emphasizes the necessity for regional myocardial infarction networks in cooperation with general physicians, emergency services and hospitals with and without interventional possibilities for rapid reperfusion therapy. Primary percutaneous coronary intervention (PCI) remains the preferred reperfusion therapy and should be carried out within the first 90 min following first medical contact and by short symptom duration even within 60 min. For antithrombotic therapy the new platelet aggregation inhibitors prasugrel and ticagrelor as well as bivalirudin for acute anticoagulation are emphasized. Detailed information is given on secondary prevention with an emphasis on physical activity and lifestyle modifications.