Tips and tricks in acute myocardial infarction

Acute ST segment elevation myocardial infarction (STEMI) most commonly results from occlusive thrombus formation after rupture of a previously undetected vulnerable plaque in a native coronary artery. As thrombus formation and endogenous thrombolysis is a dynamic process, intermittent coronary occlusion presenting as stuttering chest pain is common, especially in patients with a functioning collateral circulation. For patients presenting with ongoing chest pain and electrocardiographic changes consistent with STEMI, percutaneous coronary intervention (PCI) is emergently performed to re-establish normal antegrade blood flow and myocardial perfusion. Primary angioplasty refers to the strategy of immediate cardiac catheterization during evolving acute myocardial infarction (AMI), followed by patient triage to either angioplasty (usually in ~90% of patients), surgery (~5%, rarely emergent), or medical therapy (~5%) as dictated by the coronary anatomy, left ventricular function, and patient clinical status.