Can aggressive pharmacoinvasive therapy for ST elevation myocardial infarction achieve TIMI flow and survival comparable to primary angioplasty?
MB Sikkel, N Ruparelia, C Shirodaria, CJ McKenna, N Spyrou, J Swinburn, WP Orr Royal Berkshire Hospital, Reading, UK Background: New European guidelines recommend that patients with ST elevation myocardial infarction (STEMI) who cannot receive primary percutaneous coronary intervention (PCI) within 120 minutes of first medical contact should be thrombolysed then transferred directly to a 24/7 PCI-capable hospital. The National Infarct Angioplasty Project (NIAP) report suggests that 97% of STEMI patients in England should be treated with primary PCI by 2011, but provision of 24/7 primary PCI close enough to all patients may pose a significant logistical challenge. There are no trial data comparing primary PCI with a modern pharmacoinvasive strategy (early thrombolysis, immediate rescue PCI when required, angiography and PCI within 24 h). Such trials are required to provide an evidence-based strategy for the optimal management of STEMI, particularly for patients in whom time to primary P
Related Questions
- Should the elderly receive thrombolytic therapy, or primary angioplasty, for acute myocardial infarction?
- Should primary angioplasty be available for all patients with an ST elevation myocardial infarction?
- Does chronic ST segment elevation following Q wave myocardial infarction exclude tissue viability?
