| Prehospital management of acute ST-elevation myocardial infarction: a time for reappraisal in North America. | |
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MedLine Citation:
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PMID: 12514646 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Although the medical and technologic revolution in the last 3 decades has improved clinical outcome in patients sustaining acute ST-elevation myocardial infarction (STEMI), residual morbidity and mortality remain major health concerns. The critical roles of temporal delay and optimal sustained patency as modulators of successful reperfusion have been repeatedly demonstrated, and investigation into the ideal interface between pharmacologic and mechanical reperfusion continues. Despite physician awareness and patient education programs, time from symptom onset to treatment in STEMI remains stalled at approximately 3 hours for pharmacologic reperfusion, as documented in major clinical trials. Multifaceted improvements with advanced paramedic training, transmittable 12-lead electrocardiograms, and bolus fibrinolytics facilitate potential prehospital diagnosis and treatment. Thus, as we proceed into the 21st century, it is essential to reexamine strategies for addressing these and other issues relating to the process of delivering optimal care to most patients with STEMI. Especially notable are the opportunities provided through prehospital management with initiation of therapy, triage to appropriate hospitals, or both as major potential avenues to further enhance patient outcomes. We review past research in prehospital therapy for STEMI and practical impediments to implementation to establish a framework for interpretation of future developments. |
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Authors:
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Robert C Welsh; Joseph Ornato; Paul W Armstrong |
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Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: American heart journal Volume: 145 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2003 Jan |
Date Detail:
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Created Date: 2003-01-06 Completed Date: 2003-03-06 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 1-8 Citation Subset: AIM; IM |
Affiliation:
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University of Alberta, Edmonton, Alberta, Canada. rwelsh@cha.ab.ca |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Clinical Trials as Topic Electrocardiography* Emergency Medical Services / methods* Fibrinolytic Agents / therapeutic use Humans Myocardial Infarction / classification, therapy* Myocardial Reperfusion North America Program Development / methods Streptokinase / therapeutic use Time Factors Tissue Plasminogen Activator / therapeutic use |
| Chemical | |
Reg. No./Substance:
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0/Fibrinolytic Agents; EC 3.4.-/Streptokinase; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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