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Non-invasive treatment of ST elevation myocardial infarction
  1. J B Jones,
  2. A Docherty
  1. Department of Medicine, Wishaw General Hospital, Wishaw, UK
  1. Dr J B Jones, Department of Medicine, Wishaw General Hospital, Wishaw ML2 0DP, UK; jeremy{at}jonesonthe.net

Abstract

There is good evidence that timely restoration of coronary blood flow in obstructed infarct related arteries is a significant determinant of both short and long term mortality and morbidity. This is irrespective of whether it is achieved using fibrinolytic therapy or percutaneous coronary intervention (PCI). Despite the clear advantages of primary PCI, it is thrombolysis that remains the main reperfusion strategy in the UK. Recent data have highlighted mortality benefits when antiplatelet treatment and anticoagulation are used as adjuncts to thrombolysis. Moreover, of those who receive thrombolysis, 60% proceed to coronary arteriography within 6 months of their index event. Recent studies have been published clarifying the timing of coronary arteriography in patients who receive thrombolysis as reperfusion therapy.

  • acute myocardial infarction
  • clopidogrel
  • enoxaparin
  • percutaneous coronary intervention
  • ST elevation myocardial infarction
  • STEMI
  • thrombolysis

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Footnotes

  • Competing interests: AD was a co-investigator for EXTRACT TIMI-25 study and has held consultancy agreements with Sanofi and BMS.

  • Abbreviations:
    ARR
    absolute risk reduction
    ASSENT-4
    Assessment of the Safety and Efficacy of a New Treatment Strategy for Acute Myocardial Infarction
    CI
    confidence interval
    CLARITY
    Clopidogrel as Adjunctive Reperfusion Therapy
    COMMIT
    Clopidogrel and Metoprolol in Myocardial Infarction Trial
    ECG
    electrocardiogram
    EXTRACT
    Enoxaparin versus Unfractionated Heparin with Fibrinolysis for ST-Elevation Myocardial Infarction
    GRACIA-1
    Grupo de Analisis de la Cardiopatia Isquemica Aguda-1
    LMWH
    low molecular weight heparin
    PCI
    percutaneous coronary intervention
    REACT
    REscue Angioplasty versus Conservative treatment or repeat Thrombolysis
    RRR
    relative risk reduction
    sc
    subcutaneously
    STEMI
    ST elevation myocardial infarction
    tPA
    tissue plasminogen activator

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