Management of patients presenting with ST-elevation myocardial infarction (STEMI) has been defined by data from large, high-quality randomized clinical trials that have examined both medical and procedural therapies. Guideline-directed care based on considerable evidence from these trials supports best outcomes with prompt culprit vessel revascularization via percutaneous coronary intervention (PCI). But the realities of the management of STEMI worldwide are characterized by differences in reperfusion therapy and particularly marked variability in PCI use.1 Because lytic therapy remains a standard of care in much of the world, especially in the 10 countries within the Ticagrelor in Patients With ST-Elevation Myocardial Infarction Treated With Pharmacological Thrombolysis (TREAT) trial,2 evaluating best practices associated with improved outcomes becomes important. In the Study of Platelet Inhibition and Patient Outcomes (PLATO) trial,3 which assessed both non-ST-elevation acute coronary syndrome and STEMI treated with PCI, immediate use of ticagrelor has been shown to be superior to clopidogrel, albeit with higher bleeding risks.
Yancy CW, Harrington RA. The TREAT Trial—Moving ST-Elevation Myocardial Infarction Care Forward, With More to Do. JAMA Cardiol. 2018;3(5):399–400. doi:10.1001/jamacardio.2018.0644
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