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European Heart Journal Advance Access originally published online on July 29, 2005
European Heart Journal 2005 26(19):2063-2074; doi:10.1093/eurheartj/ehi413
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Pre-hospital reperfusion therapy: a strategy to improve therapeutic outcome in patients with ST-elevation myocardial infarction

Kurt Huber*, Raffaele De Caterina, Steen D. Kristensen, Freek W.A. Verheugt, Gilles Montalescot, Lina Badimon Maestro, Frans Van de Werf for the Task Force on Pre-hospital Reperfusion Therapy of the Working Group on Thrombosis of the ESC

3rd Medical Department (Cardiology and Emergency Medicine), Wilhelminenhospital, Montleartstrasse 37, A-1160 Vienna, Austria

Received 30 January 2005; revised 12 June 2005; accepted 16 June 2005; online publish-ahead-of-print 29 July 2005.

* Corresponding author. Tel: +43 1 49150 2301; fax: +43 1 49150 2309. E-mail address: kurt.huber@wienkav.at

This paper was guest edited by Elliott M. Antman, Brigham and Women's Hospital, Cardiovascular Division, Boston, MA, USA

The first 150 words of the full text of this article appear below.

Introduction

Therapy of acute ST-elevation myocardial infarction (STEMI) has undergone dramatic improvements during the past three decades, and in-hospital and 30-day mortality rates have tremendously decreased from >15–20% in the pre-thrombolytic area to 8–10% using fibrin-non-specific agents, to 6–8% using fibrin-specific thrombolytic agents, and down to 4.5% by the use of primary percutaneous coronary intervention (PPCI) in controlled trials by experienced centres under optimal trial conditions (Figure 1). However, translation of these results, obtained in the setting of controlled trials, into the real world, is different, as demonstrated by the results of registries. Registry data show mortality rates of >20% in patients who do not undergo reperfusion therapy within 12 h, of ~10% in thrombolysed patients, and of up to 6–8% in patients treated by PPCI. The overall success rate depends not only on the individual patient's risk (high-risk patients, e.g. patients in shock, or the elderly, usually . . . [Full Text of this Article]

The ‘golden hour’

Thrombolytic therapy
Primary PCI and transferral for primary PCI
Components of time delay in reperfusion therapy
Pre-hospital reperfusion strategies

Pre-hospital thrombolysis
‘Facilitated’ PCI
Facilitation with thrombolytic agents alone or in conjunction with glycoprotein IIb/IIIa antagonists
Facilitation with potent antiplatelet agents
GP IIb/IIIa-receptor antagonists
Clopidogrel
Summary

Acknowledgements


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