Extract
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Heart attacks are the tipping point, from the nuisance of exercise-induce angina to a potentially lethal outcome. In spite of enormous progress made since Eisenhower’s famous heart attack on 25 September 1955,1,2 acute coronary syndromes remain the major cause of mortality in Western countries, as again documented in the most recent ESC Atlas published earlier this year.3 As pointed out by Filippo Crea, Ronnie Binder, and myself in the 2017 ‘Year incardiology: acute coronary syndromes’,4 the SWEDEHEART registry5 showed that overall mortality related to this condition declined impressively, but patients presenting in cardiogenic shock or after cardiopulmonary resuscitation still have an unacceptable fatality rate. The most recent ESC guidelines in the management of ST-segment elevation myocardial infarction6 are summarized and include—among others—an upgrade on the recommendation of radial access,7,8 of drug-eluting over bare metal stents, complete revascularization, enoxaparin, and early discharge, while thrombus aspiration and bivalirudin utilization have been downgraded, particularly as with radial access there seems to be no benefit over heparin.9 Unfortunately, neither balloon pumps10 nor complete revascularization attempts have improved outcomes in shock11 so far, which will certainly modify future recommendations in this population.
