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Time to Procedure After Heart Attack Should Be Increased

Time to primary percutaneous coronary intervention should be increased to 90 to 120 minutes

TUESDAY, Sept. 30 (HealthDay News) -- The recommended time to primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction (STEMI) should be increased from under 90 minutes to 90 to 120 minutes based on current evidence, according to a commentary in the Oct. 7 issue of the Journal of the American College of Cardiology.

Christian J. Terkelsen, M.D., Ph.D., and colleagues from Aarhus University Hospital in Aarhus, Denmark, note that patients with STEMI can be treated by fibrinolytic therapy, and the 2007 updated American College of Cardiology/American Heart Association (ACC/AHA) ST-Segment Elevation Myocardial Infarction Guidelines recommend that the door-to-needle time should be 30 minutes from the time of arrival at the local hospital.

However, PPCI is acknowledged as a better reperfusion therapy, and the same guidelines recommend that PPCI should be initiated within less than 90 minutes of Emergency Medical Services arrival to balloon inflation, since it may take extra time to transport patients to a center that performs the procedure. After reviewing the current data, Terkelsen and colleagues conclude that "we would recommend that the committee responsible for the updated ACC/AHA guidelines for future revisions consider extending the acceptable PCI-related delay to 90 or 120 minutes according to the present evidence."

However, by focusing on system improvements, the recommended time is feasible, Elliott M. Antman, M.D., from Brigham and Women's Hospital in Boston, writes in an accompanying comment. "Improvements in access to timely care for patients with STEMI will require a multifaceted approach involving patient education, improvements in the Emergency Medical Services and emergency department components of care, the establishment of networks of STEMI-referral hospitals (not PCI capable) and STEMI-receiving hospitals (PCI capable), as well as coordinated advocacy efforts to work with payers and policy makers to implement a much-needed health care system redesign."

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