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Benedict M. Glover, A.A. Jennifer Adgey, Acute reperfusion strategies for ST-segment elevation myocardial infarction, European Heart Journal, Volume 29, Issue 5, March 2008, Pages 571–572, https://doi.org/10.1093/eurheartj/ehm277
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The overall aim of reperfusion therapy for patients presenting with an ST-segment elevation myocardial infarction (STEMI) is to restore normal blood flow in the infarct-related artery as rapidly and completely as possible, and thus myocardial perfusion. This can be achieved by the administration of thrombolytic therapy (either pre-hospital or in hospital) or by primary percutaneous coronary intervention (PPCI). Guidelines suggest that thrombolytic therapy should be administered within a door to needle time (or medical contact to needle time) of <30 min and a door to balloon time of <90 min for PPCI.1
Eagle et al.2 report the trends in acute reperfusion therapy from the GRACE registry for patients presenting with a STEMI from 1999 to 2006.2 There was an increase in primary PCI (from 15 to 44%) and a decline in thrombolytic therapy (from 41 to 16%). In addition, 32–40% of patients received no reperfusion therapy and a significant number of patients received reperfusion outside of the time guidelines (52% door to needle time >30 min; 42% door to balloon time >90 min).