因子 Xa 抑制剂
对用于急性冠状动脉综合征正在研究中。[63]Brito V, Ciapponi A, Kwong J. Factor Xa inhibitors for acute coronary syndromes. Cochrane Database Syst Rev. 2011;(1):CD007038.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD007038.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/21249686?tool=bestpractice.com 利伐沙班是一种因子 Xa 抑制剂，在稳定型 STEMI 患者中与双联抗血小板药物合用，能够减少心血管事件，但是增加出血事件的发生。[64]Mega JL, Braunwald E, Murphy SA, et al. Rivaroxaban in patients stabilized after a ST-segment elevation myocardial infarction: results from the ATLAS ACS-2-TIMI-51 trial (Anti-Xa Therapy to Lower Cardiovascular Events in Addition to Standard Therapy in Subjects with Acute Coronary Syndrome-Thrombolysis In Myocardial Infarction-51). J Am Coll Cardiol. 2013 May 7;61(18):1853-9.http://www.sciencedirect.com/science/article/pii/S0735109713009376http://www.ncbi.nlm.nih.gov/pubmed/23500262?tool=bestpractice.com 一项评价与 Meta 分析发现，对于 STEMI 患者，与单独使用抗血小板治疗相比，直接口服抗凝药物联合抗血小板治疗可降低缺血事件发生风险，但代价是大出血的风险增加。[65]Chiarito M, Cao D, Cannata F, et al. Direct oral anticoagulants in addition to antiplatelet therapy for secondary prevention after acute coronary syndromes: a systematic review and meta-analysis. JAMA Cardiol. 2018 Mar 1;3(3):234-41.http://www.ncbi.nlm.nih.gov/pubmed/29417147?tool=bestpractice.com
因子 IX 抑制剂
Pegnivacogin 是一种因子 IX 抑制剂，可被 anivamersen 逆转，研究表明在冠状动脉介入治疗过程中应用，与肝素静脉给药相比，能减少急性冠状动脉综合征患者的缺血事件发生率。结论来自一项未纳入 STEMI 患者的 II 期研究。一项纳入 STEMI 患者的 III 期研究正在进行中。[66]Povsic TJ, Vavalle JP, Alexander JH, et al. Use of the REG1 anticoagulation system in patients with acute coronary syndromes undergoing percutaneous coronary intervention: results from the phase II RADAR-PCI study. EuroIntervention. 2014 Aug;10(4):431-8.http://www.ncbi.nlm.nih.gov/pubmed/24929350?tool=bestpractice.com
沃拉帕沙
沃拉帕沙是蛋白酶激活受体-1 (PAR-1) 拮抗剂，一种抗血小板药物，可轻度降低心肌梗死后临床事件，但是增加出血事件。[67]Morrow DA, Braunwald E, Bonaca MP, et al. Vorapaxar in the secondary prevention of atherothrombotic events. N Engl J Med. 2012 Apr 12;366(15):1404-13.http://www.nejm.org/doi/full/10.1056/NEJMoa1200933#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/22443427?tool=bestpractice.com
左旋肉碱
对 13 项安慰剂对照试验开展的 meta 分析结果发现，左旋肉碱能显著降低急性心肌梗死患者的全因死亡率、减少室性心律失常以及改善心绞痛症状。需要进一步评估。[68]DiNicolantonio JJ, Lavie CJ, Fares H, et al. L-carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis. Mayo Clin Proc. 2013 Jun;88(6):544-51.http://www.mayoclinicproceedings.org/article/S0025-6196(13)00127-4/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/23597877?tool=bestpractice.com
骨髓干细胞治疗
已有人提出将干细胞疗法作为一种可能的治疗方法，用于急性心肌梗死后受损血管和心脏组织的修复和再生。虽然目前证据提示干细胞疗法是安全的，但它对急性心肌梗死后死亡率、生活质量和心肌功能的影响尚不清楚。[69]Fisher SA, Zhang H, Doree C, et al. Stem cell treatment for acute myocardial infarction. Cochrane Database Syst Rev. 2015;(9):CD006536.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006536.pub4/fullhttp://www.ncbi.nlm.nih.gov/pubmed/26419913?tool=bestpractice.com 然而，这是基于小型临床试验的有限证据。 [ 
]In people with acute myocardial infarction, what are the benefits and harms of stem cell treatment?https://cochranelibrary.com/cca/doi/10.1002/cca.1127/full显示答案 一项随机对照研究发现，冠状动脉内骨髓干细胞疗法安全，但对心肌功能和心肌挽救的作用尚不清楚。[70]Choudry F, Hamshere S, Saunders N, et al. A randomized double-blind control study of early intra-coronary autologous bone marrow cell infusion in acute myocardial infarction: the REGENERATE-AMI clinical trial. Eur Heart J. 2016 Jan 14;37(3):256-63.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712349/http://www.ncbi.nlm.nih.gov/pubmed/26405233?tool=bestpractice.com
