Access to Catheterization Facilities in Patients Admitted With ST-elevation Myocardial Infarction

Abstract

The primary goal of therapy for acute ST-elevation myocardial infarction (STEMI) is rapid, complete and sustained restoration of the infarct related coronary artery blood flow and myocardial perfusion, with a consequent positive impact on the patient???s outcome. Timely reperfusion of the infarct-related artery is the cornerstone of therapy for this goal.Thrombolytic therapy and percutaneous coronary intervention (PCI) are effective means to achieve reperfusion, but current trends reflect an increasing preference for PCI. Even though the development of reperfusion strategies and ancillary therapies over the last decades resulted in significant improvement in the prognosis of STEMI, the implementation of such therapies in the ???real world??? is often inefficient. Despite the increasing use of primary PCI, the proportion of eligible patients undergoing early reperfusion remained constant at about 70%, from 1994 through 1999, with roughly 30% of patients receiving neither reperfusion therapy. Findings from the GRACE study showed that nearly one ???third of patients who presented with STEMI within 12 hours and who were eligible for reperfusion therapy did not receive it. Thus, a considerable proportion of patients with STEMI do not receive reperfusion therapy for a variety of reasons. These include age, gender, concomitant comorbid conditions, delays in seeking medical attention, disparities in health system organization, ???triaging??? problems, disparities in patients??? transfer, awareness of the public, and other reasons.