Lowering mortality in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction: key prehospital and emergency room treatment strategies.
European Journal of Emergency Medicine · 2009-03-26 · Other / unclear
Abstract
Achieving optimal outcomes in patients with acute coronary syndromes depends on early reperfusion supported by rapid initiation of adjunctive antiplatelet and anticoagulant therapy. The use of the ambulance setting to initiate treatment provides an opportunity to dramatically reduce the time between symptom onset and reperfusion, and a growing body of evidence shows that prehospital reperfusion therapy is associated with significantly better short-term and long-term outcomes than in-hospital administration of the same treatment. In patients with ST-segment elevation myocardial infarction, fibrinolysis must be supported by optimal antiplatelet therapy. Recent studies have shown that, compared with aspirin monotherapy, treatment with a combination of aspirin and clopidogrel significantly improves outcome. The majority of these patients should also receive heparin (unfractionated or low molecular weight). The experience of several European emergency response systems initiating prehospital treatment, shows that this strategy is highly effective in improving outcomes for patients with acute coronary syndromes.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Antithrombotics & thrombolytics · Acetylsalicylic acid · Heparin · Mortality & survival · P2Y12 inhibitors · Time intervals
Related articles
- Facilitated reperfusion with prehospital glycoprotein IIb/IIIa inhibition: predictors of complete ST-segment resolution before primary percutaneous coronary intervention in the On-TIME 2 trial: correlates of reperfusion before primary PCI. (J Electrocardiol, 2011)
- [Acute non ST-elevation coronary syndrome in real practice of hospitals in Russia. Comparative data from RECORD 2 and RECORD registries]. (Kardiologiia, 2012)
- Risk of bleeding after prehospital administration of high dose tirofiban for ST elevation myocardial infarction. (Int J Cardiol, 2012)
- Effect of early, pre-hospital initiation of high bolus dose tirofiban in patients with ST-segment elevation myocardial infarction on short- and long-term clinical outcome. (J Am Coll Cardiol, 2010)
- Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2): a multicentre, double-blind, randomised controlled trial. (Lancet, 2008)
- [Prehospital thrombolytic therapy with tenecteplase in patients with ST-elevation myocardial infarction]. (Kardiologiia, 2008)