Time is muscle!

Acute myocardial infarction is a leading cause of death worldwide, and is responsible for approximately 42% of all deaths from cardiovascular disease.¹ Myocardial infarction (MI) refers to the ischaemia that occurs in an area of cardiac muscle when the blood supply to that area is blocked (by thrombus, atherosclerosis or embolism within the cardiac vessels). Rapid diagnosis and treatment is essential in order to save as much tissue as possible by restoring blood flow through the affected vessel. The choice of treatment depends on several factors, including the type of ischaemia and circumstance the patient is in (time and distance to the nearest hospital, accessibility of treatment, etc). Read more here.

Latest Guidelines on Managing MI

International guidelines recommend primary percutaneous coronary intervention (pPCI) as the first-line treatment for patients with ST-elevation myocardial infarction (STEMI) if it can be performed within 90 minutes of first medical contact or 2 hours after symptom onset by an experienced team. If this is not possible, then a pharmaco-invasive strategy should be followed.²

Watch Frans van de Werf discuss the latest European Society of Cardiology (ESC) guidelines on managing MI at the 2014 ESC Congress

Evidence supports Pharmaco-invasive strategy

In many circumstances timely pPCI may not be possible or feasible, for example due to prolonged transportation time, lack of facilities or expertise. In this case, a pharmaco-invasive strategy should be undertaken. This consists of intravenous thrombolysis (pre-hospital or in-hospital) using a fibrinolytic agent to dissolve the obstruction, followed by angiography within 3-24 h and coronary intervention if indicated. If there is evidence of failed reperfusion or reocclusion, the patient should be immediately transferred for rescue or urgent PCI. Read more here

The benefits of early thrombolysis have been shown both in clinical practice and also in registries, with similar 5-year survival results being seen in the real-world with pharmaco-invasive treatment for STEMI as for primary PCI.³ Results from the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial indicate that a pharmaco-invasive strategy for STEMI care is feasible for patients who cannot receive primary PCI within the recommended time window.^4-6

Watch a webcast of Paul Armstrong explaining the results of the STREAM trial.

Furthermore registries are demonstrating the real world benefits from the strategy including the French registry on Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI)^3,6 and a structured STEMI network in Sao Paulo, Brazil. The network involves 4 emergency departments and 126 ambulances and was set up to standardise treatment of STEMI and reduce delays to treatment. Results from a pilot investigation comparing patient outcomes before and after implementation of the STEMI network revealed immediate improvement in patient outcomes, in particular, a reduction in mortality for patients treated within the STEMI network system.⁷

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