Contemporary Management of ST-Elevation Myocardial Infarction

Abstract

Recent advances have caused a major shift in the way ST-elevation myocardial infarctions are managed. This review explores the pharmacological and interventional techniques that have evidence for improving outcomes and the landmark trials that have sparked change. The new P2Y inhibitors, ticagrelor and prasugrel, have been shown to be superior to clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention. Concurrently, many technical aspects of percutaneous coronary intervention have been further clarified by trial data, with bare-metal stents, routine thrombus aspiration and femoral access showing evidence of inferiority. Ongoing trials will provide more information on the role of non-culprit lesion PCI, bioresorbable vascular scaffolds, mechanical devices in persistent ischaemia and early automatic implantable cardioverter-defibrillators for inducible ventricular tachycardia.

A Novel Approach to Deliver Therapeutic Extracellular Vesicles Directly into the Mouse Kidney via Its Arterial Blood Supply

“…Directly delivering therapeutics to organs, via their arterial blood supply, has many advantages over IV injection, including minimizing systemic side effects, maximizing the therapeutic efficacy at the target site, and avoidance of first pass metabolism in the liver or sequestration by the reticuloendothelial system and lungs. While intra-arterial (IA) delivery of therapeutics is already widely clinically utilized for the treatment of stroke [5], heart attacks [6], and liver cancer [7], there are comparatively few indications for IA delivery of therapeutics for pathologies of the kidney. In part, this can be attributed to limited pre-clinical studies given that performing non-terminal IA injection into the kidneys in small animal models is technically challenging.…”