PMID- 17183049
OWN - NLM
STAT- MEDLINE
DCOM- 20070226
LR  - 20181113
IS  - 1472-0213 (Electronic)
IS  - 1472-0205 (Print)
IS  - 1472-0205 (Linking)
VI  - 24
IP  - 1
DP  - 2007 Jan
TI  - The optimum reperfusion pathway for ST elevation acute myocardial infarction: 
      development of a decision framework.
PG  - 52-6
AB  - There is currently much debate about the relative roles of pharmacological 
      reperfusion (ie, thrombolysis) and mechanical reperfusion (ie, primary 
      percutaneous coronary intervention (PPCI) in the management of patients with 
      acute ST segment elevation acute myocardial infarction (STEMI). Whilst the 
      scientific debate is reaching some resolution in terms of appropriate 
      interpretation of the evidence base, there are still significant resource issues 
      within the UK that limit our ability to implement gold standard reperfusion 
      therapy. Current evidence supports the use of one or other strategy in certain 
      situations depending on various patient-related and logistical factors. This 
      paper reviews the literature and builds the case for developing a strategic 
      approach which includes both mechanical and pharmacological interventions, 
      proposing that these are not mutually exclusive-indeed, that an approach which 
      excludes one of these interventions will not be to the benefit of all patients. 
      There is also a discussion of the role of rescue PPCI, facilitated PPCI and early 
      post thrombolysis angiography in the management of STEMI. Cardiac networks 
      throughout the UK are developing strategies to improve access to these 
      interventions and this paper offers advice on the logical selection of 
      interventions for reperfusion in the context of a clinical decision framework 
      that is evidence-based, pragmatic and develops through a series of scenarios with 
      increasing availability of resources. Four sequential scenarios are presented: 
      the first to set the scene is largely consigned to history; the last, as of yet, 
      is not robustly achievable within the UK, but represents the "optimum reperfusion 
      pathway", to which most cardiac networks are striving. Most of us currently find 
      ourselves in a period of change between the two and will relate to either 
      scenario two or three.
FAU - Kendall, J
AU  - Kendall J
AD  - Emergency Department, Frenchay Hospital, North Bristol NHS Trust, Frenchay Park 
      Road, Bristol BS16 1LE, UK. jason.kendall@nbt.nhs.uk
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Emerg Med J
JT  - Emergency medicine journal : EMJ
JID - 100963089
RN  - 0 (Fibrinolytic Agents)
SB  - IM
CIN - Emerg Med J. 2008 Feb;25(2):122; author reply 122. PMID: 18212164
MH  - *Angioplasty, Balloon, Coronary
MH  - Decision Support Techniques
MH  - Electrocardiography
MH  - Emergencies
MH  - Emergency Medical Services/methods/*standards
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Humans
MH  - Myocardial Infarction/diagnosis/drug therapy/*therapy
MH  - Patient Selection
MH  - *Thrombolytic Therapy
PMC - PMC2658158
COIS- Competing interests: None declared.
EDAT- 2006/12/22 09:00
MHDA- 2007/02/27 09:00
PMCR- 2010/01/01
CRDT- 2006/12/22 09:00
PHST- 2006/12/22 09:00 [pubmed]
PHST- 2007/02/27 09:00 [medline]
PHST- 2006/12/22 09:00 [entrez]
PHST- 2010/01/01 00:00 [pmc-release]
AID - 24/1/52 [pii]
AID - em42952 [pii]
AID - 10.1136/emj.2006.042952 [doi]
PST - ppublish
SO  - Emerg Med J. 2007 Jan;24(1):52-6. doi: 10.1136/emj.2006.042952.