This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Verheugt, F. W.A. Search for Related Content PubMed PubMed Citation Articles by Verheugt, F. W.A. Related Collections Catheter-based coronary interventions: stents Acute myocardial infarction

(Circulation. 2006;113:2377-2379.)
© 2006 American Heart Association, Inc.

Editorial

Reperfusion Therapy Starts in the Ambulance

Freek W.A. Verheugt, MD

From Heartcenter, Department of Cardiology, University Medical Center St Radboud, Nijmegen, the Netherlands.

Correspondence to Freek W.A. Verheugt, MD, FESC, FACC, Heartcenter, 670 Department of Cardiology, PO Box 9101, University Medical Center St Radboud, NL-6500-HB Nijmegen, the Netherlands. E-mail f.verheugt@cardio.umcn.nl

Key Words: angioplasty • reperfusion • fibrinolysis

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

Reperfusion therapy for ST-elevation acute coronary syndromes aims at early and complete recanalization of the infarct-related artery in order to salvage myocardium and improve both early and late clinical outcomes. The benefit rises exponentially the earlier therapy is initiated. The highest number of lives saved is within the first hour after symptom onset: the "golden hour." The exponential form of the curve relating mortality to time-to-reperfusion has major implications for the timing of treatment. The impact of delay in time-to-treatment lessens as the duration of ischemia lengthens. Consequently, reducing delays will have a much more positive return in patients presenting early for those presenting late. These considerations have provided a strong incentive for the initiation of very early reperfusion therapy.

Article p 2398

The optimal site for initiation of reperfusion strategies is the patient’s home or place where the infarction occurs. Prehospital diagnosis and treatment has been performed since 1985, when Gotsman¹ applied prehospital fibrinolytic therapy with streptokinase in Jerusalem, Israel. This strategy has proven to be feasible, relatively safe, and efficacious. The time gain with prehospital fibrinolysis is &1 hour and results in 15% relative risk reduction of early mortality.^1a Later, this form of therapy spread over the world, including the United States, where in the Seattle and Boston areas a time gain of at least 30 minutes could be reached.^2,3 The major component of time gain in prehospital triage is bypassing emergency departments of hospitals, where door-to-needle easily exceeds 30 minutes, the upper limit mandated in the guidelines. . . . [Full Text of this Article]

This article has been cited by other articles:

				F. W.A. Verheugt Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction: Trials, Registries, and Guidelines Circulation, June 23, 2009; 119(24): 3047 - 3049. [Full Text] [PDF]

				L. H. Opie and H. Selker Letter by Opie and Selker Regarding Article, "Reperfusion Starts in the Ambulance" Circulation, December 12, 2006; 114(24): e640 - e640. [Full Text] [PDF]

				F. W.A. Verheugt Response to Letter Regarding Article, "Reperfusion Starts in the Ambulance" Circulation, December 12, 2006; 114(24): e641 - e641. [Full Text] [PDF]