Topical issues of diagnosis and management of acute ST-elevation myocardial infarction
Cardiovascular diseases occupy a leading position in the structure of morbidity and mortality in most countries of the world, Europe and the Russian Federation. Despite a large number of publications on the management and treatment of acute myocardial infarction with an elevation of the ST interval, interest in this topic has not diminished due to its significant impact on mortality rates. In 2020, the Russian Cardiological Society approved an updated version of the Clinical Guidelines for the Management of Patients with Acute ST-Elevation Myocardial Infarction. The key provisions of the new recommendations are the shift in the strategy of reperfusion therapy towards the priority use of primary percutaneous intracoronary intervention, improvement of the method of prescribing modern antiplatelet drugs. The article deals with the issues of modern definition, classification and diagnostic criteria for myocardial infarction. The strategy and tactics of reperfusion therapy is determined by the time intervals during which patients are diagnosed and a decision is made to be admitted to the center of invasive cardiology. The treatment options for accompanying thrombolysis and stenting are discussed. The optimal timing of dual antiplatelet therapy for different types of reperfusion treatment (stenting, thrombolysis) is presented. The article provides information on the use of beta-blockers, angiotensin-converting enzyme inhibitors, mineralocorticoid receptor blockers in the treatment of patients with ST elevation myocardial infarction. The data on lipid-lowering therapy for myocardial infarction with an increase in the ST interval are presented.