Reperfusion treatment of ST-segment elevation myocardial infarction (STEMI) is one of the medical interventions with the largest potential for saving human lives, independently of age and gender. An attempt to reopen an acutely occluded coronary artery can be done within a wide array of possibilities, from the simple administration of aspirin to the combination of drugs and complex coronary artery interventions. Fibrinolytic drugs and aspirin represent the easiest way to attempt reperfusion and together offer an acceptable compromise between opportunity for treatment and efficacy. Other drugs and the use of invasive revascularization alternatives yield further advantages, and in some high-risk subgroups may be the most rational treatment approach. Beyond investigator's bias and dedication to either form of reperfusion treatment, interventions and/or drugs should be used as needed (and as possible) to increase the overall impact of reperfusion treatment in the community, taking advantage of the best potential of each approach. Most resources have been directed toward the improvement of reperfusion rates with the combination of fibrinolytic and antiplatelet drugs or with angioplasty. These efforts have certainly raised costs, but have not decisively improved clinical outcome nor have they broadened the impact of reperfusion treatment in the community. Indeed, the main shortcoming of reperfusion therapy is that the cohort of untreated patients is still larger than the cohort of treated patients. At a time when mortality of patients with STEMI reaching the hospital and receiving treatment has decreased significantly, the prehospital diagnosis and treatment of STEMI with the objective of enlarging the treated population and shortening the pretreatment delays is likely the best strategy to further reduce mortality. The need for a population approach to treatment of STEMI is even more obvious when considering the expanding patient load that continuously worsens its clinical risk profile, together with the increasing incidence of diabetes, obesity, hypertension, and smoking habits. The target for improving reperfusion treatment of STEMI in the future, and thereby saving more lives, seems now to involve a cultural change and fulfillment of an organizational mission more than an incremental improvement in the current pharmacologic or interventional approach. These epidemiologic and social aspects of contemporary medicine deserve full attention at a time when researchers, clinicians, and health care providers tend to focus primarily on technological advances.

中文翻译：

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ST段抬高急性心肌梗死的再灌注治疗。

ST段抬高型心肌梗死（STEMI）的再灌注治疗是最有可能挽救生命的医学干预措施之一，与年龄和性别无关。从简单的阿司匹林给药到药物联合复杂的冠状动脉介入治疗，可以在多种可能性下尝试重新打开急性阻塞的冠状动脉。纤溶药物和阿司匹林代表尝试再灌注的最简单方法，并且共同在治疗机会和功效之间提供了可接受的折衷方案。其他药物和使用侵入性血运重建替代品可产生进一步的优势，在某些高危亚组中，这可能是最合理的治疗方法。除了研究者对任何一种再灌注治疗的偏见和奉献精神之外，应根据需要（并尽可能）使用干预措施和/或药物，以增加再灌注治疗对社区的总体影响，并充分利用每种方法的最大潜力。多数资源都与纤溶酶和抗血小板药物的组合或血管成形术直接用于提高再灌注率。这些努力无疑增加了成本，但没有决定性地改善临床结果，也没有扩大社区的再灌注治疗的影响。确实，再灌注疗法的主要缺点是未治疗患者的队列仍然大于治疗患者的队列。在STEMI患者入院接受治疗的死亡率大幅下降的时候，以扩大治疗人群和缩短治疗前延迟为目标的STEMI院前诊断和治疗可能是进一步降低死亡率的最佳策略。考虑到不断增加的患者负荷不断恶化其临床风险状况，以及糖尿病，肥胖，高血压和吸烟习惯的发生率不断上升，对人群进行STEMI治疗的需求更加明显。未来改善STEMI的再灌注治疗，从而挽救更多生命的目标，现在似乎涉及的是文化变革和组织使命的实现，而不是当前药理或介入方法的逐步改进。