Title：2013 ACCF/AHA Guideline for the Management of ST Elevation Myocardial Infarction (part 2, routine medical therapies)
题目：2013年美国心脏病基金会学院（ACCF）和美国心脏病协会（AHA）ST段升高心肌梗死（STEMI）治疗指南 (第二部分：常规药物治疗)
Author 作者：Feng Xiao 肖锋
Routine Medical Therapies
常规药物治疗：
1. Aspirin 阿司匹林
Aspirin162 to 325 mg should be given before primary PCI. After PCI, aspirin should be continued indefinitely.
要在做早期PCI前给162到325mg阿司匹林。PCI后，要永远用阿司匹林。
2. P2Y12 receptor inhibitors P2Y12受体抑制剂
A loading dose of a P2Y12 receptor inhibitor should be given as early as possible or at time of primary PCI to patients with STEMI. Options include clopidogrel 600 mg or prasugrel 60 mg or ticagrelor 180 mg.
尽快或在对STEMI病人进行早期PCI时给予负荷量的P2Y12受体抑制剂，包括氯吡格雷600mg或普拉格雷60mg或替卡格雷180mg。
P2Y12 inhibitor therapy should be given for 1 year to patients with STEMI who receive a stent (bare-metal or drug-eluting) during primary PCI using the following maintenance doses: clopidogrel 75 mg daily or prasugrel 10 mg daily or ticagrelor 90 mg twice a day.
对通过PCI接受支架（裸金属或药物涂层）治疗的STEMI病人，要用一年的P2Y12受体抑制剂，其维持剂量为氯吡格雷75mg每天一次或普拉格雷10mg每天一次或替卡格雷90mg每天两次。
3. Anticoagulants 抗凝剂
For patients with STEMI undergoing primary PCI, the following supportive anticoagulant regimens are recommended: UFH, taking into account whether a GP IIb/IIIa receptor antagonist has been administered; or Bivalirudin with or without prior treatment with UFH.
对接受PCI的STEMI病人，建议应用如下的抗凝方案：普通肝素，要考虑到GPIIb/IIIa受体抑制剂的应用；或比伐卢丁（不管病人在此前用过或没用过普通肝素）。
4. Beta blockers β受体阻滞剂

Oral beta blockers should be initiated in the first 24 hours in patients with STEMI who do not have any of the following: signs of HF, evidence of a low-output state, increased risk for cardiogenic shock, or other contraindications to use of oral beta blockers (PR interval more than 0.24 seconds, second- or third-degree heart block, active asthma, or reactive airways disease).
STEMI的病人只要没有下列情况，都要在24小时内得到β受体阻滞剂：心衰体征，低心输出量，增加心源性休克的可能性，或其它应用β受体阻滞剂的禁忌症（PR间期超过0.24秒，2或3度传导阻滞，哮喘发作，或反应性呼吸道疾病）。

It is reasonable to administer intravenous beta blockers at the time of presentation to patients with STEMI and no contraindications to their use who are hypertensive or have ongoing ischemia.
对没有禁忌症但血压高或有持续性缺血的STEMI病人，在就诊时可以考虑静脉给β受体阻滞剂。

5. Angiotensin-converting enzyme inhibitors 血管紧张素转换酶抑制剂

An angiotensin-converting enzyme inhibitor should be administered within the first 24 hours to all patients with STEMI with anterior location, HF, or ejection fraction less than or equal to 0.40, unless contraindicated.
前壁心梗，心衰，或心搏指数低于0.40的STEMI病人在24小时内要给血管紧张素转换酶抑制剂，除非有禁忌症。

An angiotensin receptor blocker should be given to patients with STEMI who have indications for but are intolerant of angiotensin-converting enzyme inhibitors
如STEMI病人有如上指征，但不能耐受血管紧张素转换酶抑制剂时，可用血管紧张素受体阻滞剂。

6. Aldosterone antagonists 醛固酮拮抗剂

An aldosterone antagonist should be given to patients with STEMI and no contraindications who are already receiving an angiotensin-converting enzyme inhibitor and beta blocker and who have an ejection fraction less than or equal to 0.40 and either symptomatic HF or diabetes mellitus.
对于已经在用血管紧张速转换酶抑制剂和β受体阻滞剂，心搏指数等于或低于0.40，并有心衰的表现或糖尿病的STEMI病人，要用醛固酮拮抗剂。

7. High-intensity statins高强度的他汀类药物

High-intensity statin therapy should be initiated or continued in all patients with STEMI and no contraindications to its use.
只要没有禁忌症，高强度的他汀类药物要应用于所有的STEMI病人 。
J Am Coll Cardiol. 2013; 61(4):485-510.