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Mechanical Reperfusion for STEMI: From Randomized Trials to Clinical Practice

2010 Edition, March 26, 2010

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Active, Most Current

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ISBN: 978-1-84184-746-7
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Product Details:

  • Revision: 2010 Edition, March 26, 2010
  • Published Date: March 26, 2010
  • Status: Active, Most Current
  • Document Language: English
  • Published By: CRC Press (CRC)
  • Page Count: 310
  • ANSI Approved: No
  • DoD Adopted: No

Description / Abstract:


ST-segment elevation myocardial infarction is a leading cause of mortality in developed countries. A substantial mortality reduction has been observed in the last decades due to reperfusion therapies. Even though primary angioplasty has been shown to be superior to thrombolysis, most patients are presented in the settings-at home, in an ambulance, an emergency room, or another hospital facility—that permit the immediate use of thrombolytic therapy, but need additional referral and often long-distance transportation to allow primary angioplasty. Since time-to-treatment is a major determinant of mortality in primary angioplasty as well, mechanical reperfusion should be regarded as the preferred strategy as long as it can be applied with a reasonable time delay to treatment, as compared to the administration of thrombolysis. Building up a good regional network represents the first step in order to increase the administration and timely application of reperfusion therapies, especially primary angioplasty.

Even though primary angioplasty can achieve TIMI 3 flow in the vastmajority of patients, suboptimal myocardial reperfusion is observed in a large proportion of them. Several adjunctive pharmacological andmechanical therapies have been proposed in the last years to further improve the results of primary angioplasty, in terms of myocardial perfusion and limitation of infarct size.

The introduction of drug-eluting stent to prevent restenosis has revolutionized interventional cardiology. Several concerns have emerged on the long-term safety in terms of in-stent thrombosis, especially among primary PCI patients, when the compliance to long-term double antiplatelet therapy is not exactly predictable. However, several trials have shown that DES are safe and superior to BMS in this setting of patients.

Because of the low mortality rates currently achieved by primary angioplasty and strict inclusion criteria commonly applied in randomized trials, it is arguable whether further reduction in mortality may be observed in coming years. The adoption of surrogate endpoints, such as myocardial perfusion and infarct size, certainly represent a key point for future randomized trials.

This book aims at providing both "a piece of science" and a practical overview in the invasive management of STEMI patients.