• Nicholas Curzen, Paul A Gurbel, Aung Myat, Deepak L Bhatt, and Simon R Redwood.
• Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK. nick.curzen@uhs.nhs.uk
• Lancet. 2013 Aug 17;382(9892):633-43.

AbstractAcute ST-segment elevation myocardial infarction (STEMI) is a dynamic, thrombus-driven event. As understanding of its pathophysiology has improved, the central role of platelets in initiation and orchestration of this process has become clear. Key components of STEMI include formation of occlusive thrombus, mediation and ultimately amplification of the local vascular inflammatory response resulting in increased vasoreactivity, oedema formation, and microvascular obstruction. Activation, degranulation, and aggregation of platelets are the platforms from which these components develop. Therefore, prompt, potent, and predictable antithrombotic therapy is needed to optimise clinical outcomes after primary percutaneous coronary intervention. We review present pharmacological and mechanical adjunctive therapies for reperfusion and ask what is the optimum combination when primary percutaneous coronary intervention is used as the mode of revascularisation in patients with STEMI.Copyright © 2013 Elsevier Ltd. All rights reserved.

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