Background: Patients with ST-segment elevation myocardial infarction represent
a high-risk population and an effective antiplatelet treatment adjunctive to primary percutaneous
coronary intervention is of paramount importance.
Methods: This topic will review the current evidence on clinical efficacy and safety of oral
antiplatelet therapy in patients with an acute ST-segment elevation myocardial infarction.
Unsettled issues and future perspectives for their use in these patients are also discussed.
Results: Added to aspirin, clopidogrel, prasugrel and ticagrelor represent viable options
regarding oral P2Y12 inhibition, with prasugrel and ticagrelor being preferred over clopidogrel,
according to results of large randomized clinical trials. Early clinical efficacy of oral
antiplatelet agents in STEMI patients has been questioned, mainly because of their delayed
onset of action in the clinical setting of ST-segment elevation myocardial infarction and the
recently described adverse effect of morphine on their pharmacodynamic/pharmacokinetic profile. Whether
these agents should be administered beyond 1 year after the index event is also under discussion, as there is
clinical evidence that prolonged administration may be associated with clinical benefit.
Conclusion: Use of oral P2Y12 inhibitors in patients with ST-segment elevation myocardial infarction still faces
questions and future research is needed to establish which, when and how should be administered in this clinical