Early administration of reperfusion therapy improves survivalin patients with ST-elevation myocardial infarction by reestablishingcoronary blood flow within the occluded infarct-related artery.1Primary percutaneous coronary intervention (PCI) is superiorto fibrinolytic therapy when performed rapidly by expert teams,2but its effectiveness may be limited by delays in delivery.3
Recent national efforts are drawing attention to the importanceof door-to-balloon time as a key indicator of quality of carefor patients with ST-elevation myocardial infarction who aretreated with primary PCI.4 The American College of Cardiology(ACC), in collaboration with the American Heart Association(AHA), the American College of Emergency . . . [Full Text of this Article]
Pathophysiology of Myocardial Necrosis
Fibrinolytic Therapy
Primary PCI
Performance with Respect to Door-to-Balloon Time
Selecting a Reperfusion Therapy
Reducing Door-to-Balloon Time
Combination Strategies
Future Challenges in Improving Time to Treatment in Primary PCI
Source Information
From the Health Services Research and Development Center of Excellence, Ann Arbor Veterans Affairs Medical Center, and the Department of Internal Medicine, Division of Cardiovascular Disease, University of Michigan Medical School — both in Ann Arbor (B.K.N.); the Section of Health Policy and Administration, Department of Epidemiology and Public Health and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine, Yale University School of Medicine, New Haven, CT (E.H.B., H.M.K.); and the Section of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, and the Center for Outcomes Research and Evaluation, Yale–New Haven Hospital — both in New Haven, CT (H.M.K.).
Address reprint requests to Dr. Krumholz at 333 Cedar St., Rm. I-456 SHM, P.O. Box 208088, New Haven, CT 06520-8088, or at harlan.krumholz@yale.edu.
Related Letters:
Primary Percutaneous Coronary Intervention
Kapoor R., Kapoor J. R., Gurewich V., Szabo S., Oikonomopoulos T., Hoffmeister H. M., Nallamothu B. K., Bradley E. H., Krumholz H. M.
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N Engl J Med 2008;
358:431-433, Jan 24, 2008.
Correspondence
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