title: Total ischemic time: the correct focus of attention for optimal ST-segment elevation myocardial infarction care.
abstract: Currently accepted standards for gauging quality of care in the treatment of ST-segment elevation myocardial infarction (STEMI) mainly focus on shortening the time to treatment after the patient arrives at the hospital. But this narrow focus fails to consider the substantial duration of myocardial ischemia that exists prior to hospital arrival, and the large number of deaths that occur during the pre-hospital period. The time from symptom onset until reperfusion occurs is one estimate of total ischemic time. Several experimental studies and now human clinical studies have confirmed that infarct size and mortality are strongly correlated with the total ischemic time, and much less so with its subintervals like door-to-balloon time. This review will discuss the importance of total ischemic time in STEMI.
authors.affiliation: University of Texas, Health Science Center at Houston and Memorial Hermann Heart and Vascular Institute, Houston, Texas, USA.
authors.forename: Ali E
authors.initials: AE
authors.lastname: Denktas
authors.forename: H Vernon
authors.initials: HV
authors.lastname: Anderson
authors.forename: James
authors.initials: J
authors.lastname: McCarthy
authors.forename: Richard W
authors.initials: RW
authors.lastname: Smalling
mesh_terms: D000800:Angioplasty, Balloon; D016001:Confidence Intervals; D004632:Emergency Medical Services; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008279:Magnetic Resonance Imaging; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D017202:Myocardial Ischemia / Q000188:drug therapy* / Q000473:pathology / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods*; D016017:Odds Ratio; D013995:Time
chemical_list: D005343:Fibrinolytic Agents