Reperfusion strategies in the emergency treatment of ST-segment elevation myocardial infarction

Abstract Prompt restoration of blood flow is the primary treatment goal in ST-segment elevation myocardial infarction to optimize clinical outcomes. The ED plays a critical role in rapid triage, diagnosis, and management of ST-elevation myocardial infarction, and in the decision about which of the 2...

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Bibliographic Details
Published in:The American journal of emergency medicine 2007-03, Vol.25 (3), p.353-366
Main Authors: Peacock, W. Frank, MD, Hollander, Judd E., MD, Smalling, Richard W., MD, Bresler, Michael J., MD
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Angioplasty, Balloon, Coronary
Biological and medical sciences
Blood pressure
Cardiology. Vascular system
Contraindications
Coronary heart disease
Electrocardiography
Emergency
Emergency and intensive care: techniques, logistics
Emergency medical care
Emergency Service, Hospital
Fibrinolytic Agents - adverse effects
Fibrinolytic Agents - therapeutic use
Heart
Heart attacks
Hospitals
Humans
Intensive care medicine
Intensive care unit. Emergency transport systems. Emergency, hospital ward
Intubation
Ischemia
Medical instruments
Medical sciences
Mortality
Myocardial infarction
Myocardial Infarction - diagnosis
Myocardial Infarction - physiopathology
Myocardial Infarction - therapy
Myocardial Reperfusion
Pain
Time Factors
Veins & arteries
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Summary:Abstract Prompt restoration of blood flow is the primary treatment goal in ST-segment elevation myocardial infarction to optimize clinical outcomes. The ED plays a critical role in rapid triage, diagnosis, and management of ST-elevation myocardial infarction, and in the decision about which of the 2 recommended reperfusion options, that is, pharmacologic and mechanical (catheter-based) strategies, to undertake. Guidelines recommend percutaneous coronary intervention (PCI) if the medical contact-to-balloon time can be kept under 90 minutes, and timely administration of fibrinolytics if greater than 90 minutes. Most US hospitals do not have PCI facilities, which means the decision becomes whether to treat with a fibrinolytic agent, transfer, or both, followed by PCI if needed. Whichever reperfusion approach is used, successful treatment depends on the ED having an integrated and efficient protocol that is followed with haste. Protocols should be regularly reviewed to accommodate changes in clinical practice arising from ongoing clinical trials.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2006.07.013