Selecting the Best Reperfusion Strategy in ST-Elevation Myocardial Infarction
2003; Lippincott Williams & Wilkins; Volume: 108; Issue: 23 Linguagem: Inglês
10.1161/01.cir.0000106684.71725.98
ISSN1524-4539
AutoresRobert P. Giugliano, Eugene Braunwald,
Tópico(s)Cardiac Imaging and Diagnostics
ResumoHomeCirculationVol. 108, No. 23Selecting the Best Reperfusion Strategy in ST-Elevation Myocardial Infarction Free AccessArticle CommentaryPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessArticle CommentaryPDF/EPUBSelecting the Best Reperfusion Strategy in ST-Elevation Myocardial InfarctionIt's All a Matter of Time Robert P. Giugliano, MD, SM and Eugene Braunwald, MD Robert P. GiuglianoRobert P. Giugliano From The TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, and the Department of Medicine, Harvard Medical School, Boston, Mass. and Eugene BraunwaldEugene Braunwald From The TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, and the Department of Medicine, Harvard Medical School, Boston, Mass. Originally published9 Dec 2003https://doi.org/10.1161/01.CIR.0000106684.71725.98Circulation. 2003;108:2828–2830The primary goal of treatment of acute coronary occlusion is the achievement of early, complete, and sustained epicardial and myocardial reperfusion. Fibrinolytic therapy was first attempted in 1958,1 and, until recently, constituted the dominant approach for reperfusion. Primary coronary intervention (PCI) is now being used as an alternative to fibrinolysis with increasing frequency. This approach is supported by a recent comprehensive meta-analysis of 23 trials that demonstrated reductions in death, recurrent myocardial infarction, and stroke of 2, 4, and 1 per 100 patients treated through 30 days, respectively.2 Attempts to improve the efficacy of the standard pharmacological reperfusion regimen consisting of aspirin, unfractionated heparin, and front-loaded tissue plasminogen activator using more fibrin specific fibrinolytic agents, bolus preparations, more potent antithrombotic drugs, and platelet glycoprotein IIb/IIIa inhibitors have not reduced mortality.3 In contrast, a meta-analysis of clinical trials that compared prehospital fibrinolysis to hospital administration demonstrated a 17% relative reduction in mortality when time to treatment was reduced by an average of 1 hour.4See p 2851Thus, it became logical to compare these 2 improvements in reperfusion therapy in the Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) trial,5 in which the median time from symptom onset to therapy for patients receiving prehospital fibrinolysis was 130 minutes, and was 60 minutes longer in the primary PCI group. There was no difference at 30 days in the primary composite of death, non-fatal reinfarction, and non-fatal stroke (8.2% for fibrinolysis versus 6.2% for PCI, P=0.29) or in mortality alone (3.8% versus 4.8%, P=0.61). Furthermore, as described in a provocative analysis by Steg et al6 in the current issue of Circulation, there was a strong trend toward lower mortality (2.2% versus 5.7%, P=0.058) and a reduction of cardiogenic shock (1.3% versus 5.3%, P=0.032), but no difference in the primary triple endpoint (7.4% versus 6.6%, P=0.86) in patients treated with prehospital fibrinolysis within 2 hours of symptom onset. Thus, the above-described superiority of PCI over fibrinolysis appears not always to be present in a small but important subgroup of patients, ie, those who can receive treatment in the first 2 hours after symptom onset.Reassessment of the Golden HoursRestoration of epicardial flow, regardless of the method used, can abort infarction within the first 30 minutes after coronary occlusion (Figure), and the benefit of fibrinolytic therapy compared with placebo is considerably higher in patients treated within 2 hours after symptom onset than in those treated later.7 By reducing the time to treatment by 30 to 60 minutes, prehospital fibrinolysis results in earlier ST-segment resolution8 and increases the frequency of aborted infarction. Although successful reperfusion between 30 minutes and 2 hours can result in considerable myocardial salvage, only a minority of patients comes into contact with medical personnel within this time interval. Indeed, a large US registry showed that the combination of delays in patient presentation and those inherent in an interventional strategy result in only 8% of patients receiving primary PCI within 2 hours of symptom onset.9Download figureDownload PowerPointTime Dependent Benefit of Reperfusion. The effects of reperfusion at different times from onset of symptoms varied and were as follows: 6 hours in patients with coronary collaterals, persistent pain, and ST-segment elevation); and >6 hours, little or no myocardial salvage, with the benefits from an open IRA. The benefits of myocardial reperfusion are maximal during the first 30 minutes and then decline irrespective of the method of reperfusion. It is postulated that some benefits of an open IRA persist even when there is no myocardial salvage. IRA indicates infarct related artery.Benefits of Reperfusion After 2 to 3 HoursWith successful reperfusion more than 2 to 3 hours after symptom onset, myocardial salvage is reduced10 (particularly with fibrinolytic therapy11), preservation of the myocardium is dependent on preexisting collateral flow,10 and recovery of left ventricular function is modest.12 Primary PCI with adjunctive glycoprotein IIb/IIIa inhibitor may improve myocardial salvage compared with pharmacological reperfusion.11,12 In 1989, we expanded the then standard paradigm (early reperfusion → smaller infarct → improved survival) to include other potential benefits of an open infarct-related artery, which include perfusion of hibernating myocardium, improved healing, the prevention of infarct expansion, and of ventricular remodeling.13,14 Because PCI is very effective (>90%) at restoring epicardial flow and improving microvascular flow even hours after the onset of coronary occlusion, it is especially well suited to reap these purported benefits of arterial opening in patients who present relatively late. Although progressively longer delays in time to presentation are associated with higher rates of complications after fibrinolysis, the same pattern appears less evident for primary PCI.15A Rational Approach to Reperfusion TherapyGiven the overall superiority of primary PCI over hospital-administered fibrinolysis,2 the former has emerged as the treatment of choice when the facilities and a high-volume, experienced operator and team are readily available and the coronary anatomy is suitable. The definition of "readily available" is somewhat uncertain, although recent data suggest that outcomes with primary PCI remain superior to fibrinolysis if the added delay is less than 60 to 90 minutes.16 Longer delays in door-to-balloon time are associated with higher mortality,17 even after adjustment for differences in baseline characteristics.9When PCI is not available or when the delay between presentation to a hospital and primary PCI is anticipated to be in excess of 90 minutes (which is more likely to occur in low-volume centers, in patients requiring transfer to a second facility or presenting between 6 pm and 8 am), fibrinolytic therapy should be considered in patients who can be treated within 2 to 3 hours of symptom onset and who are not at high risk for intracranial hemorrhage. In such patients with fresh thrombus, fibrinolytic therapy is especially effective in opening an occluded infarct artery. Because the time to onset of treatment can be shortened by prehospital treatment, administration of fibrinolytic therapy in the ambulance, if available, is most appropriate in patients who present early. This may be followed by PCI to achieve maximal sustained patency of the infarct artery. Indeed, in the fibrinolytic arm of the CAPTIM trial, an early "rescue" intervention was used in 26% of patients and PCI was carried out in an additional 46% within the first month.5 The Southwest German International Study in Acute Myocardial Infarction (SIAM) III trial18 suggests that even better outcomes might have been obtained had all patients receiving early fibrinolytic therapy undergone early angiography and revascularization, as transfer for stenting within 6 hours after fibrinolytic therapy was associated with a halving (25.6% versus 50.6%, P=0.001) of the composite outcome of death, reinfarction, ischemic events, and target lesion revascularization compared with a strategy of delayed elective coronary angiography at 2 weeks.Because aging thrombi become more resistant to lysis, the efficacy of fibrinolytic therapy in establishing reperfusion and salvaging ischemic myocardium falls off with time from symptom onset, whereas the efficacy of PCI in achieving complete reperfusion and salvaging ischemic myocardium is far less time-dependent.11,19 In addition, patients who present later tend to be older, have more comorbidities, and are at increased risk for intracranial bleeding. Patients over the age of 75 years experience a 3-fold increase in death, reinfarction, or stroke after fibrinolysis compared with primary PCI.20 Thus, patients who cannot receive fibrinolytic therapy within 2 to 3 hours of symptom onset, but who can receive PCI within the next 90 minutes, should be offered this therapy, even if this entails transfer to another facility. Patients who present more than 2 to 3 hours after symptom onset with continued ischemic pain and/or ST-segment elevation, but who cannot be treated with PCI within the next 2 hours, should (if they have no contraindications) receive fibrinolytic therapy, as some myocardial salvage may still be achieved. These patients should be considered for immediate adjunctive PCI after fibrinolysis, particularly if they experience continued ischemic discomfort or ST elevation, recurrent ischemia, or have signs of left ventricular dysfunction, or later if they are not at low risk after noninvasive assessment.Patients presenting more than approximately 6 hours after symptom onset, especially patients whose chest pain and ST elevation have subsided, will demonstrate only modest benefit from fibrinolysis but may be considered for coronary angiography as soon as feasible, as this approach permits risk stratification, allows for PCI when the anatomy is suitable, and identifies patients who would benefit from coronary artery bypass surgery. The window may be longer (up to 12 hours) in patients with preexisting coronary collaterals, persistent pain, and ST-segment elevation. The benefit of even later (>48 hours) opening of an occluded infarct artery is under investigation in the ongoing Occluded Artery Trial (OAT).21Areas for Future InvestigationDespite the wealth of data generated in 2 decades of randomized clinical trials on hundreds of thousands of patients with acute ST-elevation myocardial infarction, a number of important questions remain. In patients who present within 2 to 3 hours, does a routine pharmacoinvasive approach22 that includes early fibrinolytic therapy and/or a glycoprotein IIb/IIIa inhibitor followed by immediate PCI result in additional salvage that offsets the expected increase in bleeding? Are noninvasive markers of early reperfusion after pharmacological therapy helpful in identifying patients who do not require follow-up mechanical reperfusion? Can pharmacological treatment extend the window of eligibility for PCI? Perhaps most important, how can we most effectively increase the number of patients who present immediately after the onset of symptoms, and how can we provide prehospital fibrinolytic therapy in the United States to maximize the benefit of treatment during the golden hours?The opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.FootnotesCorrespondence to: Eugene Braunwald, MD, TIMI Study Group, 350 Longwood Ave, Boston. MA 02115. E-mail [email protected] References 1 Fletcher AP, Alkjaersig N, Smyrniotis FE, et al. Treatment of patients suffering from early, myocardial infarction with massive and prolonged streptokinase therapy. Trans Assoc Am Physicians. 1958; 71: 287–296.MedlineGoogle Scholar2 Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003; 361: 13–20.CrossrefMedlineGoogle Scholar3 Boersma E, Mercado N, Poldermans D, et al. Acute myocardial infarction. Lancet. 2003; 361: 847–858.CrossrefMedlineGoogle Scholar4 Morrison LJ, Verbeek PR, McDonald AC, et al. Mortality and prehospital thrombolysis for acute myocardial infarction: a meta-analysis. JAMA. 2000; 283: 2686–2692.CrossrefMedlineGoogle Scholar5 Bonnefoy E, Lapostolle F, Leizorovicz A, et al. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet. 2002; 360: 825–829.CrossrefMedlineGoogle Scholar6 Steg PG, Bonnefoy E, Chabaud S, et al. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation. 2003; 108: 2851–2856.LinkGoogle Scholar7 Boersma E, Maas AC, Deckers JW, et al. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet. 1996; 348: 771–775.CrossrefMedlineGoogle Scholar8 Morrow DA, Antman EM, Sayah A, et al. Evaluation of the time saved by prehospital initiation of reteplase for ST-elevation myocardial infarction: results of the Early Retavase-Thrombolysis In Myocardial Infarction (ER-TIMI) 19 trial. J Am Coll Cardiol. 2002; 40: 71–77.CrossrefMedlineGoogle Scholar9 Cannon CP, Gibson CM, Lambrew CT, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA. 2000; 283: 2941–2947.CrossrefMedlineGoogle Scholar10 Milavetz JJ, Giebel DW, Christian TF, et al. Time to therapy and salvage in myocardial infarction. J Am Coll Cardiol. 1998; 31: 1246–1251.CrossrefMedlineGoogle Scholar11 Schomig A, Ndrepepa G, Mehilli J, et al. Therapy-dependent influence of time-to-treatment interval on myocardial salvage in patients with acute myocardial infarction treated with coronary artery stenting or thrombolysis. Circulation. 2003; 108: 1084–1088.LinkGoogle Scholar12 Brodie BR, Stuckey TD, Wall TC, et al. Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 1998; 32: 1312–1319.CrossrefMedlineGoogle Scholar13 Braunwald E. Myocardial reperfusion, limitation of infarct size, reduction of left ventricular dysfunction, and improved survival: should the paradigm be expanded? Circulation. 1989; 79: 441–444.CrossrefMedlineGoogle Scholar14 Kim CB, Braunwald E. Potential benefits of late reperfusion of infarcted myocardium: the open artery hypothesis. Circulation. 1993; 88: 2426–2436.CrossrefMedlineGoogle Scholar15 Zijlstra F, Patel A, Jones M, et al. Clinical characteristics and outcome of patients with early ( 4 h) presentation treated by primary coronary angioplasty or thrombolytic therapy for acute myocardial infarction. Eur Heart J. 2002; 23: 550–557.CrossrefMedlineGoogle Scholar16 Nallamothu BK, Bates ER. Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? Am J Cardiol. 2003; 42: 824–826.Google Scholar17 Berger PB, Ellis SG, Holmes DR, Jr, et al. Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in Acute Coronary Syndromes (GUSTO-IIb) trial. Circulation. 1999; 100: 14–20.LinkGoogle Scholar18 Scheller B, Hennen B, Hammer B, et al. Beneficial effects of immediate stenting after thrombolysis in acute myocardial infarction. J Am Coll Cardiol. 2003; 42: 634–641.CrossrefMedlineGoogle Scholar19 Juliard JM, Feldman LJ, Golmard JL, et al. Relation of mortality of primary angioplasty during acute myocardial infarction to door-to-Thrombolysis In Myocardial Infarction (TIMI) time. Am J Cardiol. 2003; 91: 1401–1405.CrossrefMedlineGoogle Scholar20 de Boer MJ, Ottervanger JP, van 't Hof AW, et al. Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy. J Am Coll Cardiol. 2002; 39: 1723–1728.CrossrefMedlineGoogle Scholar21 Sadanandan S, Buller C, Menon V, et al. The late open artery hypothesis: a decade later. Am Heart J. 2001; 142: 411–421.CrossrefMedlineGoogle Scholar22 Dauerman HL, Sobel BE. Synergistic treatment of ST segment elevation myocardial infarction with pharmacoinvasive recanalization. J Am Coll Cardiol. 2003; 42: 646–651.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Dreyer H, De Oliveira K, Lalloo V and Engelbrecht A (2022) A qualitative study of COVID-19 related reasons for delayed presentation of patients with chest pain during the COVID-19 pandemic, African Journal of Emergency Medicine, 10.1016/j.afjem.2021.10.002, 12:1, (34-38), Online publication date: 1-Mar-2022. Redwood E, Hyun K, French J, Kritharides L, Ryan M, Chew D, D'Souza M and Brieger D (2021) The influence of travelling to hospital by ambulance on reperfusion time and outcomes for patients with STEMI, Medical Journal of Australia, 10.5694/mja2.51005, 214:8, (377-378), Online publication date: 1-May-2021. Hoschar S, Albarqouni L and Ladwig K (2020) A systematic review of educational interventions aiming to reduce prehospital delay in patients with acute coronary syndrome, Open Heart, 10.1136/openhrt-2019-001175, 7:1, (e001175), Online publication date: 1-Mar-2020. Shibata N, Takagi K, Morishima I, Yoshioka N, Furui K, Nagai H, Kanzaki Y, Yoshida R, Morita Y, Tsuboi H and Murohara T (2019) The impact of the excimer laser on myocardial salvage in ST-elevation acute myocardial infarction via nuclear scintigraphy, The International Journal of Cardiovascular Imaging, 10.1007/s10554-019-01690-x, 36:1, (161-170), Online publication date: 1-Jan-2020. Čolaković G, Bogunović S, Anđelić S and Čolaković N (2018) Treating acute coronary syndrome in the municipal institution for emergency medical aid - Belgrade, Serbia, Naucni casopis urgentne medicine - Halo 194, 10.5937/Halo1802093C, 24:3, (93-101), . Brunetti N, De Gennaro L, Correale M, Santoro F, Caldarola P, Gaglione A and Di Biase M (2017) Pre-hospital electrocardiogram triage with telemedicine near halves time to treatment in STEMI: A meta-analysis and meta-regression analysis of non-randomized studies, International Journal of Cardiology, 10.1016/j.ijcard.2017.01.055, 232, (5-11), Online publication date: 1-Apr-2017. Du J, Cong B, Yu Q, Wang H, Wang L, Wang C, Tang X, Lu J, Zhu X and Ni X (2016) Upregulation of microRNA-22 contributes to myocardial ischemia-reperfusion injury by interfering with the mitochondrial function, Free Radical Biology and Medicine, 10.1016/j.freeradbiomed.2016.05.006, 96, (406-417), Online publication date: 1-Jul-2016. Granot M, Dagul P, Darawsha W and Aronson D (2015) Pain modulation efficiency delays seeking medical help in patients with acute myocardial infarction, Pain, 10.1016/j.pain.0000000000000020, 156:1, (192-198), Online publication date: 1-Jan-2015. Hastings C, Roche E, Ruiz-Hernandez E, Schenke-Layland K, Walsh C and Duffy G (2015) Drug and cell delivery for cardiac regeneration, Advanced Drug Delivery Reviews, 10.1016/j.addr.2014.08.006, 84, (85-106), Online publication date: 1-Apr-2015. Brunetti N, Bisceglia L, Dellegrottaglie G, Bruno A, Di Pietro G, De Gennaro L and Di Biase M (2015) Lower mortality with pre-hospital electrocardiogram triage by telemedicine support in high risk acute myocardial infarction treated with primary angioplasty: Preliminary data from the Bari–BAT public Emergency Medical Service 118 registry, International Journal of Cardiology, 10.1016/j.ijcard.2015.03.138, 185, (224-228), Online publication date: 1-Apr-2015. Brunetti N, De gennaro L, Dellegrottaglie G, Di Giuseppe G, Antonelli G and Di Biase M (2014) All for one, one for all: Remote telemedicine hub pre-hospital triage for public Emergency Medical Service 1-1-8 in a regional network for primary PCI in Apulia, Italy, European Research in Telemedicine / La Recherche Européenne en Télémédecine, 10.1016/j.eurtel.2013.11.001, 3:1, (9-15), Online publication date: 1-Mar-2014. Brunetti N, Di Pietro G, Aquilino A, Bruno A, Dellegrottaglie G, Di Giuseppe G, Lopriore C, De Gennaro L, Lanzone S, Caldarola P, Antonelli G and Di Biase M (2014) Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction, European Heart Journal: Acute Cardiovascular Care, 10.1177/2048872614527009, 3:3, (204-213), Online publication date: 1-Sep-2014. Yardimci T and Mert H (2013) Turkish patients' decision-making process in seeking treatment for myocardial infarction, Japan Journal of Nursing Science, 10.1111/jjns.12011, 11:2, (102-111), Online publication date: 1-Apr-2014. FOX K, WHITE H, GERSH B and OPIE L (2013) Antithrombotic agents: Platelet inhibitors, acute anticoagulants, fibrinolytics, and chronic anticoagulants Drugs for the Heart, 10.1016/B978-1-4557-3322-4.00018-1, (332-397), . Guglielmi A, Ieva F, Paganoni A and Ruggeri F (2013) Hospital Clustering in the Treatment of Acute Myocardial Infarction Patients Via a Bayesian Semiparametric Approach Statistical Models for Data Analysis, 10.1007/978-3-319-00032-9_17, (141-149), . Behzadi N, Salinero-Fort M, de Blas A, Taboada M, Pérez de Isla L and López-Sendón J (2012) Prehospital Thrombolysis: Two Years' Experience of the Community of Madrid Emergency Services (SUMMA 112), Revista Española de Cardiología (English Edition), 10.1016/j.rec.2012.02.009, 65:10, (960-961), Online publication date: 1-Oct-2012. Mooney M, McKee G, Fealy G, O'Brien F, O'Donnell S and Moser D (2011) A review of interventions aimed at reducing pre-hospital delay time in acute coronary syndrome: what has worked and why?, European Journal of Cardiovascular Nursing, 10.1016/j.ejcnurse.2011.04.003, 11:4, (445-453), Online publication date: 1-Dec-2012. Behzadi N, Salinero-Fort M, de Blas A, Taboada M, Pérez de Isla L and López-Sendón J (2012) Dos años de fibrinolisis extrahospitalaria: experiencia del SUMMA 112 en la Comunidad de Madrid, Revista Española de Cardiología, 10.1016/j.recesp.2012.02.010, 65:10, (960-961), Online publication date: 1-Oct-2012. Comelli I, Vignali L, Rolli A, Lippi G and Cervellin G (2011) Achievement of a median door-to-balloon time of less than 90 minutes by implementation of organizational changes in the 'Emergency Department to Cath Lab' pathway: a 5-year analysis, Journal of Evaluation in Clinical Practice, 10.1111/j.1365-2753.2011.01673.x, 18:4, (788-792), Online publication date: 1-Aug-2012. Kozak M and Chambers C (2011) Cardiac Catheterization Laboratory Kaplan's Cardiac Anesthesia: The Echo Era, 10.1016/B978-1-4377-1617-7.00003-0, (33-73), . Brokalaki H, Giakoumidakis K, Fotos N, Galanis P, Patelarou E, Siamaga E and Elefsiniotis I (2011) Factors associated with delayed hospital arrival among patients with acute myocardial infarction: a cross-sectional study in Greece, International Nursing Review, 10.1111/j.1466-7657.2011.00914.x, 58:4, (470-476), Online publication date: 1-Dec-2011. Galvez-Monton C, Prat-Vidal C, Roura S, Farre J, Soler-Botija C, Llucia-Valldeperas A, Diaz-Guemes I, Sanchez-Margallo F, Aris A and Bayes-Genis A (2011) Transposition of a pericardial-derived vascular adipose flap for myocardial salvage after infarct, Cardiovascular Research, 10.1093/cvr/cvr136, 91:4, (659-667), Online publication date: 1-Sep-2011. Kempf T, Zarbock A, Widera C, Butz S, Stadtmann A, Rossaint J, Bolomini-Vittori M, Korf-Klingebiel M, Napp L, Hansen B, Kanwischer A, Bavendiek U, Beutel G, Hapke M, Sauer M, Laudanna C, Hogg N, Vestweber D and Wollert K (2011) GDF-15 is an inhibitor of leukocyte integrin activation required for survival after myocardial infarction in mice, Nature Medicine, 10.1038/nm.2354, 17:5, (581-588), Online publication date: 1-May-2011. DeVon H, Hogan N, Ochs A and Shapiro M (2010) Time to Treatment for Acute Coronary Syndromes, Journal of Cardiovascular Nursing, 10.1097/JCN.0b013e3181bb14a0, 25:2, (106-114), Online publication date: 1-Mar-2010. Wong C and White H (2009) Fibrinolysis for Acute Myocardial Infarction New Therapeutic Agents in Thrombosis and Thrombolysis, 10.3109/9781420069242.037, (651-666), Online publication date: 1-Jun-2009. Ganova-Iolovska M, Kalinov K and Geraedts M (2009) Quality of care of patients with acute myocardial infarction in Bulgaria: a cross-sectional study, BMC Health Services Research, 10.1186/1472-6963-9-15, 9:1, Online publication date: 1-Dec-2009. FOX K, WHITE H, OPIE J, GERSH B and OPIE L (2009) Antithrombotic Agents: Platelet Inhibitors, Anticoagulants, and Fibrinolytics Drugs for the Heart, 10.1016/B978-1-4160-6158-8.50014-9, (293-340), . Rosell-Ortiz F, Mellado-Vergel F, Ruiz-Bailén M and Perea-Milla E (2008) Out-of-Hospital Treatment and 1-Year Survival in Patients With ST-Elevation Acute Myocardial Infarction. Results of the Spanish Out-of-Hospital Fibrinolysis Evaluation Project (PEFEX), Revista Española de Cardiología (English Edition), 10.1016/S1885-5857(08)60063-8, 61:1, (14-21), Online publication date: 1-Jan-2008. Rosell-Ortiz F, Mellado-Vergel F, Ruiz-Bailén M and Perea-Milla E (2008) Tratamiento extrahospitalario y supervivencia al año de los pacientes con infarto agudo de miocardio con elevación de ST. Resultados del Proyecto para la Evaluación de la Fibrinólisis Extrahospitalaria (PEFEX), Revista Española de Cardiología, 10.1157/13114952, 61:1, (14-21), Online publication date: 1-Jan-2008. Dzielicka E and Swanton H (2008) Optimal reperfusion strategy for acute myocardial infarction, British Journal of Hospital Medicine, 10.12968/hmed.2008.69.1.28036, 69:1, (18-23), Online publication date: 1-Jan-2008. Stephen S, Darney B and Rosenfeld A (2008) Symptoms of acute coronary syndrome in women with diabetes: An integrative review of the literature, Heart & Lung, 10.1016/j.hrtlng.2007.05.006, 37:3, (179-189), Online publication date: 1-May-2008. Kusama I, Hibi K, Kosuge M, Nozawa N, Ozaki H, Yano H, Sumita S, Tsukahara K, Okuda J, Ebina T, Umemura S and Kimura K (2007) Impact of Plaque Rupture on Infarct Size in ST-Segment Elevation Anterior Acute Myocardial Infarction, Journal of the American College of Cardiology, 10.1016/j.jacc.2007.07.004, 50:13, (1230-1237), Online publication date: 1-Sep-2007. Rosell Ortiz F, Mellado Vergel F, Ruiz Bailén M, García Alcántara A, Reina Toral A, Arias Garrido J and Álvarez Bueno M (2007) Síndrome coronario agudo con elevación del segmento ST (SCACEST). Estrategia de consenso para una reperfusión precoz. Empresa pública de emergencias sanitarias (EPES) y grupo ARIAM-Andalucía, Medicina Intensiva, 10.1016/S0210-5691(07)74857-X, 31:9, (502-509), Online publication date: 1-Dec-2007. Djordjevic-Radojkovic D, Perisic Z, Tomasevic M, Pavlovic M, Apostolovic S, Jankovic R, Damjanovic M, Salinger-Martinovic S, Bozinovic N and Milenkovic D (2007) Influence of the double antiplatelet therapy on patency of the infarct related artery after acute myocardial infarction with ST-segment elevation, Vojnosanitetski pregledMilitary Medical and Pharmaceutical Journal of Serbia, 10.2298/VSP0702117D, 64:2, (117-121), . Raffel O and White H (2007) Acute Coronary Syndromes Cardiothoracic Critical Care, 10.1016/B978-075067572-7.50021-7, (257-277), . Kirk J (2007) Reducing the door to balloon time: Is bypassing the emergency department really the answer?, International Journal of Cardiology, 10.1016/j.ijcard.2007.01.001, 119:3, (359-361), Online publication date: 1-Jul-2007. Bradley E, Nallamothu B, Curtis J, Webster T, Magid D, Granger C, Moscucci M and Krumholz H (2007) Summary of Evidence Regarding Hospital Strategies to Reduce Door-to-Balloon Times for Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention, Critical Pathways in Cardiology: A Journal of Evidence-Based Medicine, 10.1097/HPC.0b013e31812da7bc, 6:3, (91-97), Online publication date: 1-Sep-2007. Sura A and Kelemen M (2006) Early Management of ST-segment Elevation Myocardial Infarction, Cardiology Clinics, 10.1016/j.ccl.2005.09.011, 24:1, (37-51), Online publication date: 1-Feb-2006. Wong C, Gao W, Raffel O, French J, Stewart R and White H (2006) Initial Q waves accompanying ST-segment elevation at presentation of acute myocardial infarction and 30-day mortality in patients given streptokinase therapy: an analysis from HERO-2, The Lancet, 10.1016/S0140-6736(06)68929-0, 367:9528, (2061-2067), Online publication date: 1-Jun-2006. Heras M, Marrugat J, Arós F, Bosch X, Enero J, Suárez M, Pabón P, Ancillo P, Loma-Osorio Á, Rodríguez J, Subirana I and Vila J (2006) Reducción de la mortalidad por infarto agudo de miocardio en un período de 5 años, Revista Española de Cardiología, 10.1157/13086076, 59:3, (200-208), Online publication date: 1-Mar-2006. Heras M, Marrugat J, Arós F, Bosch X, Enero J, Suárez M, Pabón P, Ancillo P, Loma-Osorio Á, Rodríguez J, Subirana I and Vila J (2006) Reduction in Acute Myocardial Infarction Mortality Over a Five-Year Period, Revista Española de Cardiología (English Edition), 10.1016/S1885-5857(06)70022-6, 59:3, (200-208), Online publication date: 1-Mar-2006. Rutsch W Lyse HerzAkutMedizin, 10.1007/3-7985-1630-8_17, (249-287) Mayer D and Rosenfeld A (2016) Symptom Interpretation in Women With Diabetes and Myocardial Infarction, The Diabetes Educator, 10.1177/0145721706294262, 32:6, (918-924), Online publication date: 1-Nov-2006. Steinwender C, Hofmann R, Kammler J, Kypta A, Pichler R, Maschek W, Schuster G, Gabriel C and Leisch F (2006) Effects of peripheral blood stem cell mobilization with granulocyte–colony stimulating factor and their transcoronary transplantation after primary stent implantation for acute myocardial infarction, American Heart Journal, 10.1016/j.ahj.2006.03.012, 151:6, (1296.e7-1296.e13), Online publication date: 1-Jun-2006. van den Bos E, Baks T, Moelker A, Kerver W, van Geuns R, van der Giessen W, Duncker D and Wielopolski P (2006) Magnetic resonance imaging of haemorrhage within reperfused myocardial infarcts: possible interference with iron oxide-labelled cell tracking?, European Heart Journal, 10.1093/eurheartj/ehl059, 27:13, (1620-1626), Online publication date: 1-Jul-2006. Wollert K and Drexler H (2005) Clinical Applications of Stem Cells for the Heart, Circulation Research, 96:2, (151-163), Online publication date: 4-Feb-2005. (2005) Part 5: Acute coronary syndromes, Resuscitation, 10.1016/j.resuscitation.2005.09.019, 67:2-3, (249-269), Online publication date: 1-Nov-2005. Rosenfeld A, Lindauer A and Darney B (2005) Understanding Treatment-Seeking Delay in Women with Acute Myocardial Infarction: Descriptions of Decision-Making Patterns, American Journal of Critical Care, 10.4037/ajcc2005.14.4.285, 14:4, (285-293), Online publication date: 1-Jul-2005. Hazui H, Fukumoto H, Negoro N, Hoshiga M, Muraoka H, Nishimoto M, Morita H and Hanafusa T (2005) Simple and Useful Tests for Discriminating Between Acute Aortic Dissection of the Ascending Aorta and Acute Myocardial Infarction in the Emergency Setting, Circulation Journal, 10.1253/circj.69.677, 69:6, (677-682), . Manfredini R and Boari B (2004) Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty, Circulation, 109:18, (e219-e219), Online publication date: 11-May-2004. Wollert K, Meyer G, Lotz J, Ringes Lichtenberg S, Lippolt P, Breidenbach C, Fichtner S, Korte T, Hornig B, Messinger D, Arseniev L, Hertenstein B, Ganser A and Drexler H (2004) Intracoronary autologous bone-marrow cell transfer after myocardial infarction: the BOOST randomised controlled clinical trial, The Lancet, 10.1016/S0140-6736(04)16626-9, 364:9429, (141-148), Online publication date: 1-Jul-2004. Carta M, Sancassiani F, Bina D, Licciardi M, Cossu G, Nardi A, Meloni L and Montisci R (2022) Alexithymia is a determinant of early death in the long-term course of post-myocardial infarction, Journal of Public Health Research, 10.4081/jphr.2022.2803, 11:2 Li Q, Ge Z, Xiang Y, Tian D, Tang Y and Zhang Y (2022) Upregulation of microRNA-34a enhances myocardial ischemia-reperfusion injury via the mitochondrial apoptotic pathway, Free Radical Research, 10.1080/10715762.2021.1953004, (1-16) Faddy S, McMullen M and Faddy S (2014) Bypass for primary percutaneous intervention or thrombolysis at the nearest hospital for patients suffering ST-elevation myocardial infarction Cochrane Database of Systematic Reviews, 10.1002/14651858.CD010936 Faddy S and McMullen M (2016) Bypass for primary percutaneous intervention or thrombolysis at the nearest hospital for patients suffering ST-elevation myocardial infarction, Cochrane Database of Systematic Reviews, 10.1002/14651858.CD010936.pub2 December 9, 2003Vol 108, Issue 23 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000106684.71725.98PMID: 14662688 Originally publishedDecember 9, 2003 Keywordsmyocardial infarctionfibrinolysisEditorialsangioplastyreperfusionPDF download Advertisement
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