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(Circulation. 2003;108:1768.)
© 2003 American Heart Association, Inc.

Focused Perspective

All Hospitals Are Not Equal for Treatment of Patients With Acute Myocardial Infarction

W. Douglas Weaver, MD

From the Henry Ford Heart and Vascular Institute, Detroit, Mich.

Correspondence to W. Douglas Weaver, MD, Darin Chair of Cardiology and Co-Director, Henry Ford Heart and Vascular Institute, 2799 West Grand Boulevard, Detroit, MI 48202. E-mail wweaver1@hfhs.org

Key Words: Focused Perspectives • myocardial infarction • angiography • thrombolysis • angioplasty

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

	Introduction

 
Over the past several years, mounting evidence has shown that emergent angiography and primary angioplasty (or perhaps more appropriately named primary percutaneous coronary intervention [PCI]) are superior to treatment with thrombolytic therapy and watchful waiting for treatment of acute myocardial infarction (AMI).^1,2 This is particularly true for patients at high risk for death (eg, those >70 years of age), those who present to hospital late (4 hours after AMI), and those with prior myocardial infarction or diabetes.³ Primary PCI has advantages of higher initial TIMI 3 flow rates, less reocclusion, and less recurrent ischemia and reinfarction when compared with thrombolytic drug treatment and watchful waiting. Emergent angiography also permits early risk stratification, assessment of left ventricular function, and identification of other complications. In addition, early intervention has also been shown to be the best therapeutic option in patients with moderate and high-risk features who have non–ST-elevation infarction.^4–6

See p 1809

Today, in this country as well as in others, most patients with AMI are admitted to suburban or rural hospitals, many without catheterization labs and many more without angioplasty facilities. Although long ago, we decided that the treatment of serious trauma was best done in specialized centers, patients with AMI, despite an overall mortality rate of 10%, are managed in any hospital with a coronary care unit. Few are transferred at the time of admission, and most receive thrombolytic therapy and then watchful waiting for complications. First, it has been generally held that the delay in transferring a patient . . . [Full Text of this Article]

Related Article:

Transfer for Primary Angioplasty Versus Immediate Thrombolysis in Acute Myocardial Infarction: A Meta-Analysis

M. Dalby, A. Bouzamondo, P. Lechat, and G. Montalescot
Circulation 2003 108: 1809-1814. [Abstract] [Full Text]

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