From Concept to Reality: A Decade of Progress in Regional ST-Elevation Myocardial Infarction Systems

摘要: > Perseverance is not a long race: it many short races one after another. > > —Walter Elliott, 19th Century spiritual writer The treatment and outcome of patients with ST-segment elevation myocardial infarction (STEMI) has improved dramatically over the 30 years since I graduated from medical school. In 1982, bed rest, complications such as ventricular arrhythmias or mural thrombus prayer (for those so inclined) were standard care. first decade, pharmacological therapy was developed, open artery hypothesis confirmed. The Second International Study Infarct Survival (ISIS-2) trial demonstrated benefit only aspirin, but also combination aspirin streptokinase1 leading to series randomized clinical trials determine preferred fibrinolytic adjunctive medications. second decade filled that compared primary percutaneous coronary intervention (PCI), which ultimately confirmed PCI method reperfusion if performed in timely manner high-volume centers.2 European extended benefits STEMI who presented non-PCI centers requiring transfer for PCI.3,4 particular, Danish Multicenter Randomized on Thrombolytic Therapy versus Acute Coronary Angioplasty Myocardial Infarction (DANAMI-2), well-designed, multicenter, including 24 referral hospitals 5 Denmark, stopped early when significant reduction end point death, reinfarction, stroke at days (8% 13.7% fibrinolysis, P <0.001).4 Article see p 189 These stimulated interest regional systems United States, believed would be challenging replicate results seen small country short-duration transfers (mean, 34 miles) an organized national emergency system (EMS).5 2002, …