text: Antiplatelet therapy is a mainstay of pharmacotherapy in STEMI. In the International Study of Infarct Survival 2 (ISIS 2), the thromboxane inhibitor aspirin reduced mortality in STEMI as much as streptokinase (by approximately 42%) when compared to the administration of neither agent.<unk> s inhibit ADP mediated platelet activation and have been found to further improve outcomes of STEMI patients treated with a fibrinolytic agent for STEMI. There are at present three approved agents available in this class, ticlopidine, clopidogrel and prasugrel.  As an adjunct to fibrinolytic therapy, clopidogrel has been associated with improved patency in the CLARITY trial (300 mg loading dose and 75 mg/day maintenance dose), and a reduction in mortality in the COMMIT trial (75 mg/day loading and maintenance dose). Among STEMI patients treated with a fibrinolytic agent, co-administration of clopidogrel at a loading dose of 300 mg and a maintenance dose of 75 mg/day should be viewed as the standard of care.
  In contrast to fibrinolytic therapy, the benefit of<unk>  therapy among primary angioplasty patients has not been established in randomized trials. The benefit of aspirin plus<unk>  therapy versus aspirin monotherapy alone could be difficult to establish in randomized trials given that the majority of STEMI patients are treated with a stent which in turn obviates chronic<unk>  treatment.  Despite the required chronic<unk>  therapy following stent placement, the slower onset of action of oral<unk> s relative to that of parenteral antiplatelet agents such as glycoprotein IIb/IIIainhibitors raises important questions as to the acute / early benefits of glycoprotein IIb/IIIa inhibitors versus<unk> s. Furthermore, the optimal timing of<unk>  therapy in primary PCI is not well established. In so far a few patients undergo coronary artery bypass grafting (CABG) surgery urgently in the setting of STEMI, the need to define the anatomy prior to theinopyridine administration may not be as compelling as it is in the setting of stable angina, unstable angina and non-ST elevation MI.
  Uncertainty remains with respect to the following issues that have not been addressed in randomized trials:
option_0: ST elevation myocardial infarction thienopyridine therapy
option_1: ST elevation myocardial infarction aspirin therapy
option_2: ST elevation myocardial infarction nitrate therapy
option_3: ST elevation myocardial infarction calcium channel blocker therapy
option_4: ST elevation myocardial infarction anticoagulant and antithrombotic therapy
option_5: ST elevation myocardial infarction beta blocker therapy
option_6: ST elevation myocardial infarction fibrinolytic therapy
option_7: ST elevation myocardial infarction adjunctive percutaneous coronary intervention