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Editorial
Focusing on prehospital care to improve ST elevation myocardial infarction care
  1. Milena S Marcolino1,
  2. Antonio L Ribeiro1,2
  1. 1 Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  2. 2 Department of Cardiology, University Hospital Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  1. Correspondence to Professor Antonio L Ribeiro, Internal Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais 30310-770, Brazil; tom1963br{at}yahoo.com.br

https://doi.org/10.1136/heartjnl-2019-315475

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    Our understanding of the relationship between time to reperfusion of the occluded coronary artery and mortality precedes the widespread acceptance of primary percutaneous coronary intervention (PPCI) as front-line treatment for ST elevation myocardial infarction (STEMI), when thrombolytic therapy was considered the ‘gold standard’ in treatment.1 With PPCI, it was observed that, even after adjusting for age and comorbidities, the risk of 1-year mortality increased by 7.5% for every 30 min of delay to treatment.2 Additionally, a shorter time to treatment was observed to be associated with a lower risk for readmission and the development of secondary congestive heart failure.3 Then, treatment delays have been established as a performance measure of quality of care in STEMI.

    In the past few years, emergency medical services (EMS) have been recognised as having a critical role on the success of achieving time to reperfusion according to the guidelines, mostly by performing prehospital ECG for faster identification of a suspected STEMI and direct transfer of the patient to the catheterisation laboratory.4 5 Therefore, EMS have been …

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    Footnotes

    • Contributors Both authors contributed equally to this editorial.

    • Funding ALR is supported by grants of the Brazilian Research agencies Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq) and Fundação de Amparo a Pesquisa do Estado de Minas Gerais (FAPEMIG). ALR and MSM are members of the National Institute of Science and Technology for Health Technology Assessment (IATS/CNPq).

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Commissioned; internally peer reviewed.

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