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(Circulation. 2007;116:6-9.)
© 2007 American Heart Association, Inc.

Editorial

The ST-Segment–Elevation Myocardial Infarction Chain of Survival

Joseph P. Ornato, MD

From the Department of Emergency Medicine, Virginia Commonwealth University, Richmond.

Correspondence to Joseph P. Ornato, MD, Virginia Commonwealth University, Department of Emergency Medicine, 1201 East Marshall St, AD Williams 2nd Floor, Richmond, VA 23298-0401. E-mail ornato@aol.com

Key Words: Editorials • infarction • myocardium

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

The benefit of expertly performed, timely, primary percutaneous coronary intervention (PCI) over fibrinolysis is clear for patients with ST-segment–elevation myocardial infarction (STEMI). Primary PCI is superior to fibrinolysis for reduction of overall short-term mortality, nonfatal reinfarction, stroke, and the combined end point of death, nonfatal reinfarction, and stroke.¹ These results remain valid during long-term follow-up and are independent of both the type of fibrinolytic used and whether the patient is transferred for primary PCI.

Article p 67

Although the relationship between time delay from hospital emergency department arrival to fibrinolytic treatment and increasing mortality has been firmly established,² a similar relationship for primary PCI treatment has been proven only recently. De Luca et al³ assessed the relationship between ischemic time and 1-year mortality in 1791 primary PCI-treated STEMI patients. After adjustment for age, gender, diabetes, and previous revascularization, these investigators showed that every 30 minutes of primary PCI treatment delay is associated with a 7.5% (95% CI, 1.008 to 1.15; P=0.041) relative increase in 1-year mortality. With use of hierarchical models adjusted for patient characteristics to evaluate the effect of door-to-balloon time on in-hospital mortality on 29 222 PCI-treated STEMI patients treated in 6 hours of presentation at 395 hospitals that participated in the National Registry of Myocardial Infarction–3 and –4 from 1999 to 2002, McNamara et al⁴ found that a longer door-to-balloon time interval is associated with increased in-hospital mortality. Adjusted for patient characteristics, patients with a door-to-balloon time interval >90 minutes were more likely to die (odds . . . [Full Text of this Article]

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