The last 2 decades have witnessed a revolution in acute reperfusion
therapy for ST-segment elevation myocardial infarction (STEMI). This therapy
has focused on patients who present within the first 12 hours of infarction,
in the belief that the benefit of therapy is minimal after that time. However,
a significant minority of patients present with STEMI more than 12 hours after
the onset of chest pain. In 2 large registry studies,1,2 patients
presenting after 12 hours represented 8.5% and 31.3% of all patients with
STEMI. Available randomized trial evidence has until now suggested little
role for acute reperfusion therapy in this setting. The Fibrinolytic Therapy
Trialist Collaboration3 reported that mortality
was not reduced by thrombolytic therapy in patients presenting after 12 hours.
Based on these data, existing clinical practice guidelines4,5 strongly
favor the use of acute reperfusion therapy in patients presenting within 12
hours but are more cautious about the potential value of reperfusion therapy
in patients presenting later than 12 hours. However, the lack of benefit may,
in part, be due to the inability of thrombolytic drugs to restore patency
in vessels that have been occluded for several hours.6
Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more
Subscribe for full-text access to content from 1998 forward and a host of useful features
Activate your current subscription (AMA members and current subscribers)
Purchase Online Access to this article for 24 hours
Some tools below are only available to our subscribers or users with an online account.
Download citation file:
Web of Science® Times Cited: 2
Customize your page view by dragging & repositioning the boxes below.
More Listings atJAMACareerCenter.com >
and access these and other features:
Enter your username and email address. We'll send you a link to reset your password.
Enter your username and email address. We'll send instructions on how to reset your password to the email address we have on record.
Athens and Shibboleth are access management services that provide single sign-on to protected resources. They replace the multiple user names and passwords necessary to access subscription-based content with a single user name and password that can be entered once per session. It operates independently of a user's location or IP address. If your institution uses Athens or Shibboleth authentication, please contact your site administrator to receive your user name and password.