STEMI care 2021: Addressing the knowledge gaps

Tremendous progress has been made in the treatment of ST-segment elevation myocardial infarction (STEMI), the most severe and time-sensitive acute coronary syndrome. Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion, which has stimulated the development of regional STEMI systems of care with standardized protocols designed to optimize care. However, challenges remain for patients with cardiogenic shock, out-of-hospital cardiac arrest, an expected delay to reperfusion (>120 min), in-hospital STEMI, and more recently, those with Covid-19 infection. Ultimately, the goal is to provide timely reperfusion with primary PCI coupled with the optimal antiplatelet and anticoagulant therapies. We review the challenges and provide insights into the remaining knowledge gaps for contemporary STEMI care. STEMI Care 2021. Regional STEMI systems of care with standardized STEMI protocols ensure higher PCI rates and better survival rates (upper); however, several unique challenges remain in STEMI care (bottom). EMS: Emergency medical service; PCI: Percutaneous coronary intervention; STEMI: ST-segment elevation myocardial infarction. Bar graph adapted with permission from Shah RU. et al. [12]. Created by using BioRender.com. [Display omitted]