What question did this study set out to answer?

This paper aims to explore the historical development and impact of coronary reperfusion strategies on STEMI outcomes.

July 14, 2014Open Access

The history of coronary reperfusion

Q: What is the clinical evidence from this study?

Study design: Review. Population: ST-segment-elevation myocardial infarction (STEMI). Intervention: Coronary reperfusion (primary PCI and thrombolysis).

Key Result

Reperfusion therapy for STEMI, including primary PCI and thrombolysis, has reduced early mortality from 16-18% historically to approximately 4% in modern randomized trials.

Key Points

This paper aims to explore the historical development and impact of coronary reperfusion strategies on STEMI outcomes.
Review of clinical trials and studies related to STEMI treatment and reperfusion therapy.
Analysis of early mortality rates in relation to advances in treatments over two decades.
Comparison of primary PCI and thrombolysis outcomes based on published trials.
Early mortality rates for STEMI have decreased from 16-18% to approximately 4% due to reperfusion therapy advancements.
Primary PCI is the treatment of choice for STEMI, especially when performed within 90-120 minutes of presentation.
Coronary thrombolysis provided key insights into the benefits of reperfusion strategies.

PICO

Population

ST-segment-elevation myocardial infarction (STEMI)

Intervention / Comparator

Coronary reperfusion (primary PCI and thrombolysis)

Abstract

The incidence and fatality rates of an acute ST-segment-elevation myocardial infarction (STEMI) are going down in Western countries as a result of better prevention and treatment. However, STEMI remains a leading cause of death in the industrialized world. It is likely that STEMI will also become a major cause of death in developing countries due to the reduced mortality from infectious diseases and the adoption of a Western life style. ST-segment-elevation myocardial infarction is generally precipitated by rupture or erosion of an atherosclerotic plaque triggering the formation of an occlusive coronary thrombus. To rescue jeopardized myocardium, rapid restoration of coronary blood flow is critical. Thus, prompt induction of complete and sustained infarct-related artery recanalization is paramount. Over the course of two decades early mortality has declined from 16 to 18% before this paradigm was established (see, e.g. the mortality rates in the control group of the Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardio (GISSI-1) trial1 to ±4% in recent randomized clinical trials focusing on either pharmacological or mechanical revascularization or both ( Figure 1 ). Reperfusion therapy is one of the most successful therapies of modern medicine. Figure 1 Early mortality rates in major randomized STEMI trials: 1986–2008. Although primary percutaneous coronary intervention (PCI) is presently the treatment of choice, no patients have been studied comparing primary PCI against no reperfusion therapy. In contrast, a large number of patients with STEMI have been studied with lytic agents in placebo-controlled trials. Thus, much of our knowledge of the benefits of reperfusion came from results obtained in large and carefully performed studies of coronary thrombolysis. Today, primary PCI is the preferred strategy if the procedure can be performed by an experienced team within 90–120 min after the patient first presents.2,3 It is preferred because it can confer more rapid and …

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