Investigation of Factors Influencing the Incidence and Prognosis of Acute Myocardial Infarction

Abstract

Coronary heart disease (CHD) is the leading cause of death and disability and has a major impact on both developing and developed nations. The acute manifestation of CHD is defined as an acute coronary syndrome (ACS). The two main cornerstones of the treatment of this condition are the immediate administration of antiplatelet agents after diagnosis and the reperfusion therapy, most commonly percutaneous coronary intervention (PCI), during which the vascular segment responsible for the development of acute myocardial infarction (AMI) is identified and treated by mechanical reperfusion and implantation of stents in the coronary artery stenoses. Although the therapeutic options and strategy for ACS have developed fast in the last decades, there are still unresolved questions in need of further clarification. Regarding the administration of antiplatelet drugs immediately after diagnosis (being most commonly clopidogrel and aspirin in Hungary), previous studies demonstrated large interindividual differences in response to clopidogrel. The term “clopidogrel resistance” was created and widely applied to refer to patients with an inappropriate response, which raised important questions regarding the treatment of AMI. Another major issue regarding the treatment of ACS is the type of stents implanted during PCI in different patient populations since nowadays not only bare-metal stents (BMS) but also stents delivering antiproliferative drugs (drug-eluting stent, DES) are available. In recent years several new anticoagulants (direct oral anticoagulant, DOAC) have been introduced for various indications. Since the use of these drugs concerns large patient populations it brings up important questions regarding their cardiovascular safety.