MINI-SYMPOSIUM
It’s a matter of time: contemporary pre-hospital management of acute ST elevation myocardial infarction
University of Alberta, Edmonton, Alberta, Canada
Correspondence to:
Correspondence to:
Dr Robert C Welsh
University of Alberta, 2C2.12, Walter Mackenzie Centre, 8440 - 112 Street, Edmonton, Alberta T6G 2B7, Canada; rwelsh@cha.ab.ca
Abbreviations: EMS, emergency medical system; MI, myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST elevation myocardial infarction
Keywords: ST elevation myocardial infarction
| The first 150 words of the full text of this article appear below. |
Substantial intellectual and financial resources have been invested in the quest to reduce outcomes in patients with ST elevation myocardial infarction (STEMI) through improved pharmacological and mechanical reperfusion therapies. By contrast, little emphasis has been placed on enhancing the medical systems whereby these treatments are delivered, especially as it relates to pre-hospital reperfusion. In this article we will review (1) the importance of timely reperfusion, (2) data supporting pre-hospital fibrinolysis, and (3) a novel contemporary systems based approach to improving outcomes in patients with acute cardiac events.
Delay in treatment is associated with a substantial reduction in the benefit of fibrinolysis as demonstrated in a meta-analysis of greater than 50 000 patients with STEMI.1 Treatment within the first hour of symptoms achieves twice the benefit of subsequent treatment (< 1 hour = 65/1000 patients treated lives v 1–2 hours = 37 lives/1000 patients treated). This validated experimental models of acute
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