title: Accelerating time to reperfusion in acute myocardial infarction: prehospital and emergency department strategies, systems of care, and pharmacologic interventions.
abstract: Although primary percutaneous coronary intervention has emerged as the preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI), it is available only in a minority of US hospitals. The fundamental problem is that there is presently no organized, uniform, national STEMI triage and treatment system that is comparable to the well-developed, highly successful system in the United States that directs major trauma victims to verified trauma centers. This article reviews prehospital and emergency department triage strategies, systems, and pharmacologic interventions for patients with STEMI that can help shorten the time to reperfusion in these patients.
authors.affiliation: Department of Emergency Medicine, Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Ornato
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000925:Anticoagulants / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D001792:Blood Platelets / Q000187:drug effects; D002317:Cardiovascular Agents / Q000494:pharmacology / Q000627:therapeutic use*; D000077144:Clopidogrel; D003153:Community Health Services / Q000458:organization & administration; D019091:Critical Pathways / Q000458:organization & administration; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006297:Health Services Accessibility / Q000458:organization & administration*; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000097:blood / Q000188:drug therapy / Q000628:therapy*; D010348:Patient Care Team / Q000458:organization & administration*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016730:Program Development; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage / Q000458:organization & administration; D014481:United States
chemical_list: D000319:Adrenergic beta-Antagonists; D000925:Anticoagulants; D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D006493:Heparin; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin