Delay time in suspected acute myocardial infarction and the importance of its modification

Herlitz, Johan; Blohm, M; Hartford, Marianne; Hjalmarsson, Anna; Holmberg, Stig; Karlson, BW

doi:10.1002/clc.4960120704

Cited by 38 publications

(15 citation statements)

References 20 publications

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“…This delay should be reduced by better infor mation to the public, as shown possible in sev eral studies [17,18], Patients aged 75 years or more were -in the study period -as a rule not thrombolyzed. In the light of the results from the GISSI study [1], showing a trend towards and the ISIS-2 study [4] showing a significant reduction in mortality after thrombolytic therapy in elder ly patients with the same low frequency of complications, the age criterion has recently been removed from the thrombolysis instruc tions at our CCU.…”

Section: Discussionmentioning

confidence: 99%

Thrombolysis in Acute Myocardial Infarction

Haastrup

Gill²,

Haghfeli³

1994

Cardiology

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In order to describe the execution of thrombolytic therapy in acute myocardial infarction (AMI) in a coronary care unit, case records of 427 admissions in 1992 due to definite or possible AMI were reviewed: 32% received thrombolytic therapy while 68% did not because of contraindications, delayed admission, advanced age or nondiagnostic ECG changes. Among cases otherwise eligible for thrombolytic therapy according to the instructions of the department, 32% did not receive thrombolytic treatment solely because of nondiagnostic ECG changes. There is an obvious need for implementation of improved early diagnostic tools in the decision-making of thrombolysis as for instance newer, sensitive biochemical markers and continuous vectorcardiography.

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Section: Discussionmentioning

confidence: 99%

Thrombolysis in Acute Myocardial Infarction

Haastrup

Gill²,

Haghfeli³

1994

Cardiology

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“…Of these, approximatety 25% die, half of them before reaching a hospital [49,72]. Importantly, patients who survive acute myocardial infarction are at increased risk of recurrent myocardial infarction or cardiac death.…”

Section: Aktuelle Aspekte Der Sekundiirpriivention Nach Akutem Myokarmentioning

confidence: 99%

Current concepts in secondary prevention after acute myocardial infarction

Mehta

Bossone

Eagle

2000

Herz

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Acute myocardial infarction (MI) is the leading cause of death around the globe. Advances in the field of cardiology have identified several effective treatments that have lead to decrease in mortality from this cause over the past 3 decades. The purpose of this article is to review the existing literature in regards to secondary prevention after acute MI. A search of MEDLINE through August of 1999 was carried out to identify any available publications on secondary prevention after MI. Evidence on the use of both pharmacological and nonpharmacological interventions that was shown to be effective in improving morbidity and mortality was sought. Recommendations for the treatment of patients with acute MI are made based on existing evidence. Betablockers, aspirin and lipid-lowering agents for patients with low density lipoprotein-cholesterol > 130 mg% should be used for all patients following a MI. Angiotensin converting enzyme inhibitors are indicated for patients with congestive heart failure and/or reduced left ventricular ejection fraction and are likely protective in most patients. Calcium channel blockers (Verapamil and Diltiazem) are indicated as second-line therapy for patients who have contraindications or are intolerant to betablockers. The routine prophylactic use of antiarrhythmic drugs to suppress ventricular ectopic beats should be avoided. Recommendations regarding diet, smoking cessation and achievement of ideal body weight should be an integral part of patient management. Referral for outpatient rehabilitation should also be strongly encouraged. Finally, adequate control of blood pressure and diabetes cannot be overemphasized. Adherence to these goals in patients with acute MI will lead to better long-term outcomes and reduction in cardiac death, recurrent MI, stroke, and need for coronary revascularization.

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“…Despite the significant decline in the death rate over the last decade, acute MI remains a fatal condition in approximately one third of these patients [1]. Given that almost half of these deaths occur within the first hour of an acute MI as the result of fatal arrhythmias [2], it is imperative to educate patients to recognize the symptoms of acute MI early and to expedite the diagnosis of this condition such that effective treatment can be rapidly initiated. Almost all MIs, especially those associated with STsegment elevation on the presenting electrocardiogram, occur due to the rupture of a vulnerable plaque, with subsequent acute thrombosis and platelet aggregation that results in the sudden total or subtotal occlusion of the culprit artery [3].…”

Section: Introductionmentioning

confidence: 99%

ST-segment elevation myocardial infarction

Yeghiazarians

Stone

2002

Curr Treat Options Cardio Med

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ST-segment elevation myocardial infarction (MI) is an emergency medical condition. Expediting the steps leading to coronary reperfusion is of critical importance in improving survival after acute MI. After the diagnosis of acute MI is made, patients should be treated with oxygen, aspirin, nitroglycerin, beta-blockers, heparin, and analgesics, barring any contraindications. If an experienced cardiac catheterization laboratory is available within 60 to 90 minutes, then catheter-based reperfusion therapy is recommended; otherwise, thrombolysis should be considered as an alternate therapy. Therapy with a reduced-dose thrombolytic agent and a glycoprotein IIb/IIIa receptor inhibitor appears to be of an added benefit in establishing TIMI (Thrombolysis in Myocardial Infarction) 3 flow, but this approach awaits final approval prior to widespread use. The adjunctive use of glycoprotein IIb/IIIa receptor inhibitors with percutaneous transluminal coronary angioplasty, with or without stenting, appears to be beneficial and is being used more frequently in the acute setting. Coronary angiography should be performed in patients who fail to respond to thrombolytic therapy or who have evidence of recurrent ischemia. This procedure should not be routinely performed in patients who have responded to thrombolytic therapy. Four to 6 days after an acute MI event, assessment of left ventricular function is recommended. Submaximal exercise test (with or without nuclear or echocardiographic imaging) should be considered in patients prior to discharge from the hospital--an exception can be made in patients with one-vessel disease treated successfully with percutaneous transluminal coronary angioplasty. After discharge, a regular exercise test should be obtained 4 to 6 weeks after an uncomplicated acute MI event. Secondary prevention measures such as weight loss, cessation of smoking, aspirin, beta-blockers, lipid-lowering agents, and angiotensin-converting enzyme inhibitors should be considered in all patients, barring contraindications.

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Delay time in suspected acute myocardial infarction and the importance of its modification

Cited by 38 publications

References 20 publications

Thrombolysis in Acute Myocardial Infarction

Thrombolysis in Acute Myocardial Infarction

Current concepts in secondary prevention after acute myocardial infarction

ST-segment elevation myocardial infarction

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