Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android


Content Update

ECLS-SHOCK Trial Review

The ECLS-SHOCK trial evaluated the impact of extracorporeal life support (ECLS) on mortality in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock. Read More

Content Update

MULTISTARS AMI: MULTIvessel Immediate versus STAged RevaScularization in Acute Myocardial Infarction

The MULTISTARS AMI trial was a prospective, randomized, noninferiority trial designed to compare the safety and efficacy of immediate versus staged percutaneous coronary intervention (PCI) of nonculprit vessels among hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease, after successful primary PCI of the infarct-related coronary artery. Read More

Content Update

BIOVASC: Immediate Versus Staged Complete Revascularization in ACS and Multivessel Disease

The BIOVASC trial was a prospective, open-label, non-inferiority, randomized, multinational clinical trial designed to assess whether immediate versus staged (within 6 weeks after the index procedure) complete revascularization improves outcomes in patients with acute coronary syndromes (ACS) and multivessel coronary disease. Read More

Content Update

BRIGHT-4: a randomized trial of bivalirudin in patients with ST-segment elevation myocardial infarction

BRIGHT-4 was an open-label, randomized trial comparing bivalirudin utilizing a post-percutaneous coronary intervention (PCI) high-dose infusion protocol to heparin alone in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI. Read More

Content Update


The SECURE trial is an open-label, multinational trial that randomized 2,499 patients aged ≥65 years with a prior type 1 myocardial infarction (MI) within the 6 months preceding enrollment to a polypill-based strategy with a single pill containing aspirin (100 mg), ramipril (2.5, 5 or 10 mg) and atorvastatin (20 or 40 mg), or to usual care. Read More

Content Update

PACMAN-AMI: Effects of the PCSK9 Antibody Alirocumab on Coronary Atherosclerosis in Patients with Acute Myocardial Infarction

The PACMAN-AMI trial sought to evaluate effects of PCSK9 inhibition on atherosclerotic plaque progression via serial intracoronary imaging of non-culprit plaques in patients presenting with acute myocardial infarction (MI) on high-intensity statin therapy. Read More

Chapter Summary

This chapter describes the epidemiology, mechanisms of disease, and management of ST-segment elevation myocardial infarction (STEMI; see Fuster and Hurst’s Central Illustration). The incidence of STEMI is decreasing in the United States and Europe. However, while advances in treatment and secondary prevention strategies have led to a reduction of short-term and long-term mortality in patients with STEMI, mortality remains substantial. STEMI results from acute occlusion of an epicardial coronary artery. Depending on the size of the territory distal to the occlusion site, the global left ventricular function can be significantly impaired, resulting in postinfarction chronic heart failure. Electrical and mechanical complications may also complicate STEMI and are discussed. The final extent of necrosis (myocardial infarct size) is one of the major determinants of prognosis after STEMI and is mainly the result of two processes: ischemia and subsequent reperfusion. Timely reperfusion (by primary percutaneous coronary intervention [PCI] or a pharmaco-invasive ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.