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(Circulation. 2003;107:1471.)
© 2003 American Heart Association, Inc.

Mini-Review: Expert Opinions

Editor’s Commentary

Centers of Excellence

James T. Willerson, MD

From St Luke’s Episcopal Hospital/Texas Heart Institute, Houston.

Correspondence to James T. Willerson, MD, SLEH/THI, 6720 Bertner Ave, Room B524 (MC 1-267), Houston, Texas 77030.

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Drs Califf and Faxon¹ and Topol and Kereiakes² have made a strong case for the creation of Special Centers of Excellence for the rapid and effective treatment of acute myocardial infarction in patients. Their reviews have summarized advances in cardiovascular medicine that have shown that interventional therapy with angioplasty and stents provide improved outcomes for patients with ST-segment elevation myocardial infarcts. Carefully selected patients may also benefit from thrombolytic therapy in combination with potent antiplatelet therapies. Patients with unstable angina and non–ST-segment elevation infarcts should be treated intensively with medications that prevent sustained thrombosis and vasoconstriction. Those with increases in serum troponins with unstable angina and those with increases in serum C-reactive protein with unstable angina and non–ST-segment elevation infarcts benefit from potent antithrombotic medications and coronary artery revascularization. Time is of the essence, however, especially for those patients with acute myocardial infarctions, and the more rapidly one can open the infarct-related artery in patients with ST-segment elevation infarcts and prevent repetitive and/or sustained coronary artery occlusions in those with non–ST-segment elevation infarcts, the better for the individual patient.

The educated opinions expressed in this issue by the experienced physician-scientists cited above^1,2 need to be taken seriously by hospitals, community leaders, and our government. The real issue is not whether the creation of Specialized Centers for the care of these patients would provide an important advance, but rather how to create them. The transport of patients over long distances with consequent extended delays in their treatment will not be beneficial . . . [Full Text of this Article]

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