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(Circulation. 2006;114:e641.)
© 2006 American Heart Association, Inc.

Correspondence

Response to Letter Regarding Article, "Reperfusion Starts in the Ambulance"

Freek W.A. Verheugt, MD, FESC

Department of Cardiology,, HeartLung Centre, University Medical Center, Nijmegen, The Netherlands

I agree with the comments on my article¹ by Opie and Selker stating that any therapy to prevent reperfusion injury in the management of ST-elevation myocardial infarction should begin as soon as possible before reperfusion, preferably in the ambulance. However, clinical trials supporting glucose–insulin–potassium infusion in myocardial infarction treated in the hospital do not support this.^2,3 This treatment option has not been studied in the ambulance, but if effective, it is probably too complex to be implemented. A second option would be the start of N-acetylcysteine infusion,⁴ because data suggest that this may improve outcome, even in the era of primary angioplasty.⁵ This approach needs confirmation in more trials, however. If effective, this simple therapy to prevent reperfusion injury should be started in the ambulance.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 

1. Verheugt FW. Reperfusion therapy starts in the ambulance. Circulation. 2006; 113: 2377–2379.[Free Full Text]
   
2. Henriques JPS, Dambrink JHE, Van den Broek SAJ, Van der Horst ICC, Zijlstra F. Glucose-insulin-potassium infusion in patients with acute myocardial infarction without signs of heart failure: the Glucose-Insulin-Potassium Study (GIPS-II). J Am Coll Cardiol. 2006; 47: 1730–1731.[Free Full Text]
   
3. CREATE-ECLA trial group investigators. Effect of glucose-insulin-potassium infusion on mortality in patients with acute ST-segment elevation myocardial infarction: the CREATE-ECLA randomized controlled trial. JAMA. 2005; 293: 437–446.[Abstract/Free Full Text]
   
4. Arstall MA, Yang J, Stafford I, Betts WH, Horowitz JD. N-acetylcysteine in combination with nitroglycerin and streptokinase for the treatment of evolving acute myocardial infarction: safety and biochemical effects. Circulation. 1995; 92: 2855–2862.[Abstract/Free Full Text]
   
5. Marenzi G, Assanelli E, Marana I, Lauri G, Campodonico J, Grazi M, DeMetrio M, Galli S, Fabbiocchi F, Montorsi P, Veglia F, Bartorelli AL. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med. 2006; 354: 2773–2782.[Abstract/Free Full Text]
   

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