Mini-Focus Issue: STEMI
State-of-the-Art Paper
Total Ischemic Time: The Correct Focus of Attention for Optimal ST-Segment Elevation Myocardial Infarction Care

https://doi.org/10.1016/j.jcin.2011.02.012Get rights and content
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Currently accepted standards for gauging quality of care in the treatment of ST-segment elevation myocardial infarction (STEMI) mainly focus on shortening the time to treatment after the patient arrives at the hospital. But this narrow focus fails to consider the substantial duration of myocardial ischemia that exists prior to hospital arrival, and the large number of deaths that occur during the pre-hospital period. The time from symptom onset until reperfusion occurs is one estimate of total ischemic time. Several experimental studies and now human clinical studies have confirmed that infarct size and mortality are strongly correlated with the total ischemic time, and much less so with its subintervals like door-to-balloon time. This review will discuss the importance of total ischemic time in STEMI.

Key Words

coronary angioplasty
ischemic time
myocardial infarction
pre-hospital fibrinolysis
reperfusion
STEMI

Abbreviations and Acronyms

CI
confidence interval
FAST-PCI
fibrinolytic acceleration of ST-segment elevated myocardial infarction treatment coupled with urgent culprit artery revascularization
MSI
myocardial salvage index
MVO
microvascular obstruction
OR
odds ratio
PCI
percutaneous coronary intervention
PHF
pre-hospital fibrinolysis
STEMI
ST-segment elevation myocardial infarction
TIMI
Thrombolysis In Myocardial Infarction

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The authors have reported that they have no relationships to disclose.