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(Circulation. 2003;107:2543.)
© 2003 American Heart Association, Inc.

Mini-Review: Expert Opinions

Editor’s Commentary: One Size Does Not Fit All

James T. Willerson, MD

From Circulation, SLETH/TI, Houston, Tex.

Correspondence to James T. Willerson, MD, Circulation, SLEH/THI, 6720 Bertner Ave, Room B 524 (MC 1-267), Houston, TX 77030.

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

In this present series of "Mini-Review: Expert Opinions," leading clinical investigators present their cases for treatment of acute ST-segment elevation myocardial infarction with thrombolytic therapy or percutaneous coronary intervention (PCI). The investigators review relevant studies and their own experience that support their positions.

A review of information provided by Drs Armstrong, Collen, and Antman¹ and Grines, Serruys, and O’Neill,² as well as other relevant literature related to the treatment of acute ST-elevation myocardial infarcts, would lead the unbiased reviewer to conclude that the optimal therapy presently available is an acute intervention, ie, PCI (or surgical revascularization), if that procedure can be done by experts within at least 90 minutes of the event. One obtains the most rapid opening of the infarct-related artery and the best perfusion of the infarct-injured zone associated with no or little risk of intracerebral hemorrhage with PCI. However, this is not always possible to do. Many infarcts occur in the early morning hours in patients at considerable distances from a hospital where such therapy is available. In other cases, the necessary facility may not be available in a timely manner or an experienced and capable operator may not be present. Although patients have been transported over some distance to reach a hospital where such therapy can be given, it still appears that if this process requires several hours to accomplish, the real advantage of PCI is markedly diminished. There are patient subsets where PCI is also preferable, and these include, among others, the very elderly, patients . . . [Full Text of this Article]

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				M. Ivanusa, P. W. Armstrong, D. Collen, and E. Antman Fibrinolytic Therapy: What Size to Fit All? * Response Circulation, December 23, 2003; 108 (25): e170 - e170. [Full Text] [PDF]