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Acute coronary syndromes

Right direction—moving proximally in timing of STEMI care

Major controversy exists about whether to treat patients with ST-segment elevation myocardial infarction using fibrinolysis or percutaneous intervention. A study of 1,492 patients from approximately 60% of French hospitals demonstrates that similarly excellent 5-year outcomes can be achieved with either reperfusion strategy. Therefore, one size need not necessarily fit all.

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References

  1. Danchin, N. et al. Five-year survival in patients with ST-segment elevation myocardial infarction according to modalities of reperfusion therapy: the French Registry on Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) 2005 cohort. Circulation 129, 1629–1636 (2014).

    Article  CAS  Google Scholar 

  2. Armstrong, P. W. et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N. Engl. J. Med. 368, 1379–1387 (2013).

    Article  CAS  Google Scholar 

  3. Roe, M. T. et al. Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. J. Am. Coll. Cardiol. 56, 254–263 (2010).

    Article  Google Scholar 

  4. Terkelsen, C. J. et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA 304, 763–771 (2010).

    Article  CAS  Google Scholar 

  5. Lambert, L. et al. Association between timeliness of reperfusion therapy and clinical outcomes in ST-elevation myocardial infarction. JAMA 303, 2148–2155 (2010).

    Article  CAS  Google Scholar 

  6. Concannon, T. W., Nelson, J., Kent, D. M. & Griffith, J. L. Evidence of systematic duplication by new percutaneous coronary intervention programs. Circ. Cardiovasc. Qual. Outcomes 6, 400–408 (2013).

    Article  Google Scholar 

  7. McGrath, P. D. et al. Relation between operator and hospital volume and outcomes following percutaneous coronary interventions in the era of the coronary stent. JAMA 284, 3139–3144 (2000).

    Article  CAS  Google Scholar 

  8. Armstrong, P. W. & Boden, W. E. Reperfusion paradox in ST-segment elevation myocardial infarction. Ann. Intern. Med. 155, 389–391 (2011).

    Article  Google Scholar 

  9. O'Gara, P. T. et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. J. Am. Coll. Cardiol. 61, e87–e140 (2013).

    Article  Google Scholar 

  10. Huber, K., Gersh, B. J., Goldstein, P., Granger, C. B. & Armstrong, P. W. The organization, function, and outcomes of ST-elevation myocardial infarction networks worldwide: current state, unmet needs and future directions. Eur. Heart J. http://dx.doi.org/10.1093/eurheartj/ehu125.

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Correspondence to Paul W. Armstrong.

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The author declares that he is a consultant for, and has received research grants for the STREAM trial and honoraria from, Boehringer Ingelheim.

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Armstrong, P. Right direction—moving proximally in timing of STEMI care. Nat Rev Cardiol 11, 320–321 (2014). https://doi.org/10.1038/nrcardio.2014.61

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