Timely reperfusion therapy in patients with acute ST-segment-elevation myocardial
infarction (STEMI) greatly reduces the mortality rate associated with STEMI, according to an
article in the Medical Journal of Australia.
Professor Derek Chew, Professor of Cardiology at Flinders University and Regional Director
of Cardiology at Flinders Medical Centre, Adelaide, and co-authors conducted a study to
describe the contemporary management and outcomes of patients presenting with STEMI in
Australia, and to determine the factors associated with timely reperfusion and the effects of
reperfusion on mortality.
Professor Chew said that timely reperfusion, not the modality of reperfusion, was associated
with significant outcome benefits. However, Australian use of timely, or any, reperfusion
remains poor and incomplete.
"Our findings provide a strong case for continued audit and possible system redesign of our
acute coronary syndromes management through a nationwide ongoing clinical registry,"
Professor Chew said.
In an accompanying editorial in the Medical Journal of Australia Dr Ian Scott, Director of the
Department of Internal Medicine and Clinical Epidemiology at the Princess Alexandra
Hospital, Brisbane, reviewed the procedures involved in providing early coronary reperfusion
in patients with STEMI.
Dr Scott said that, in patients with STEMI, early coronary reperfusion within 1-2 hours of
symptom onset reduces the mortality rate by half. However, this benefit quickly dissipates
with further delay in treatment.
He said a multifaceted approach was needed to reduce ischaemic time. This would involve
educating both patients and doctors; coordinating ambulance, emergency department and
cardiac catheterisation laboratory components of care; establishing integrated networks of
non-PCI and PCI-capable hospitals with decisions to support and transfer processes that take
patient risk and time to presentation into account; and ongoing data collection and feedback
within clinical registries.
The Medical Journal of Australia is a publication of the Australian Medical Association.
Source:
Medical Journal of Australia