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ST-Segment Elevation Myocardial Infarction: Recommendations on Triage of Patients to Heart Attack Centers

Is it Time for a National Policy for the Treatment of ST-Segment Elevation Myocardial Infarction?

Timothy D. Henry, MD^_*,_*, James M. Atkins, MD, Michael S. Cunningham, MD, Gary S. Francis, MD, William J. Groh, MD, MPH^||, Robert A. Hong, MD^¶, Karl B. Kern, MD^#, David M. Larson, MD^_**, Erik Magnus Ohman, MD, Joseph P. Ornato, MD, Mary Ann Peberdy, MD, Michael J. Rosenberg, MD and W. Douglas Weaver, MD^||||

^_* Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
Southwestern Medical Center, Dallas, Texas
Southpoint Cardiology, Jacksonville, Florida
Cleveland Clinic Foundation, Cleveland, Ohio
^|| Krannert Institute of Cardiology, Indianapolis, Indiana
^¶ John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
^# University of Arizona Medical Center, Tucson, Arizona
^_** Ridgeview Medical Center, Waconia, Minnesota
Duke University, Durham, North Carolina
Virginia Commonwealth University Health System, Richmond, Virginia
Advocate Lutheran General Hospital, Park Ridge, Illinois
^|||| Henry Ford Heart and Vascular Institute, Detroit, Michigan

View larger version (31K): [in a new window]   Figure 1 Trials comparing direct percutaneous coronary intervention with thrombolytic therapy show a significant reduction in events with primary percutaneous coronary intervention. PTCA = percutaneous transluminal coronary angioplasty. Reprinted, with permission, from Keeley et al. (15).

View larger version (15K): [in a new window]   Figure 2 Meta-analysis of six randomized trials comparing transfer for primary percutaneous coronary intervention (PCI) versus on-site thrombolysis shows a significant reduction in the combined end point of death, reinfarction, or stroke favoring transfer for PCI. Reprinted, with permission, from Dalby et al. (34).