Revascularization for Acute Myocardial Infarction: The Evidence

Antonio Fernández-Ortiz, Javier Jiménez-Candil, Vicente Bodí, José A. Barrabés

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Early reperfusion is the cornerstone of treatment for patients with ST-elevation acute coronary syndrome. The sooner it is carried out, the better the outcome. According to scientific research, primary percutaneous coronary intervention is superior to fibrinolysis in terms of morbidity and mortality, and it is the treatment of choice when the time to coronary intervention does not exceed 90-120. min. If the delay before reperfusion by percutaneous coronary intervention is expected to be >120. min, it is recommended that fibrinolytic treatment should be started. Therefore, a major limitation to the more widespread use of primary percutaneous coronary intervention as a technique for coronary reperfusion is the substantial delay between first contact with the medical services and balloon inflation (i.e. the system delay) that occurs in the real world where transport times are long and there are a limited number of hospitals that can provide primary percutaneous coronary intervention on a 24-hour basis 365 days of the year. To improve this situation, the most recent treatment recommendations emphasize the importance of prehospital diagnosis and the need for an efficiently organized network of ambulances and hospitals that enables system delays to be minimized. This would make the best reperfusion therapy, namely primary percutaneous coronary intervention, available to the vast majority of patients with ST-elevation acute coronary syndrome. © 2011 Sociedad Española de Cardiología.
Original languageEnglish
Pages (from-to)9-14
JournalRevista Espanola de Cardiologia Suplementos
Issue numberSUPPL. 3
Publication statusPublished - 24 Oct 2011


  • Door-to-balloon time
  • Door-to-needle time
  • Fibrinolysis
  • Primary percutaneous coronary intervention


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