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Invasive treatment may be more effective for heart attack patients presenting late to hospital

Invasive treatment including stenting may have better outcomes than conventional treatments for heart attack patients who arrive at the hospital more than 12 hours after symptoms began, according to a study in the June 15 issue of JAMA.

In patients with acute ST-segment elevation myocardial infarction (STEMI - a certain finding on an electrocardiogram, suggesting a heart attack), numerous studies have demonstrated that early reperfusion (restoration of blood flow) within 12 hours of symptom onset is associated with increased myocardial (heart muscle) salvage, preservation of left ventricular function, and improved survival, according to background information in the article. Due to time-dependent reduction in the efficacy of thrombolysis (administration of medications to help dissolve blood clots), the application of this reperfusion method after 12 hours from symptom onset of acute myocardial infarction (MI, heart attack) offers little or no benefit and may be even harmful. Between 8.5 percent to 40 percent of patients with acute MI present late after symptom onset, thus being no longer eligible for thrombolysis.

Despite efforts to reduce time to presentation, recent studies have demonstrated that time-to-arrival at the hospital after the onset of symptoms has not changed or has even increased. Several findings suggest that reperfusion therapy may be beneficial even among patients with acute MI who present late after symptom onset. Current guidelines do not recommend reperfusion treatment in these patients. No specifically designed studies have addressed the role of primary percutaneous coronary intervention (PCI) in patients with STEMI presenting more than 12 hours after symptom onset.

Albert Schmig, M.D., of Technische Universitt, Munich, Germany, and colleagues conducted a study to assess whether an invasive strategy based on PCI with stenting is associated with reduction of infarct (dead tissue from lack of blood) size in patients with
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Contact: Albert Schmig, M.D.
aschoemig@dhm.mhn.de
JAMA and Archives Journals
14-Jun-2005


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