ST-segment elevation myocardial infarction management in Europe.
The rate of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction varies between European countries, as does total mortality as a result of acute myocardial infarction. These differences arise partly because of differences between countries in the time delay from symptom onset to first medical contact, and from first medical contact to reperfusion with thrombolysis or PCI. The European Society of Cardiology guidelines emphasize the importance of early reperfusion therapy. There are, however, often logistical delays in transport of the patient, in diagnosis of myocardial infarction and in preparation of medical teams to be available to perform PCI. Studies have shown that door-to-balloon time may improve with an integrated approach coordinating systems, procedures and institutions, and steps such as including prehospital triage and prehospital electrocardiogram transmission can dramatically reduce door-to-balloon time. Early transfer to PCI is associated with fewer ischaemic complications.
UTIC, Dipartimento Cardiovascolare, Ospedale San Filippo Neri, Rome, Italy. m.tubaro@alice.it
Marco
M
Tubaro
Anna
A
Sonia Petronio
D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D002985:Clinical Protocols; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D004562:Electrocardiography; D004632:Emergency Medical Services; D005060:Europe / Q000453:epidemiology; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010348:Patient Care Team; D010360:Patient Transfer; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome