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Invasive Management of Patients With ST Elevation Myocardial Infarction With > 12-h Delay in Presentation : The Question Remains Unanswered

Wen-Chih Wu, MD; Paul C. Gordon, MD
Author and Funding Information

Affiliations: Providence, RI
 ,  Dr. Wu is Assistant Professor of Medicine at Brown Medical School. Dr. Gordon is Director, Cardiac Catheterization Laboratory and Coronary Care Unit, The Miriam Hospital.

Correspondence to: Wen-Chih Wu, MD, Division of Cardiology, Veterans Affairs Medical Center, 830 Chalkstone Ave, Providence, RI 02908; e-mail: wen-chih_wu@brown.edu



Chest. 2004;126(1):2-4. doi:10.1378/chest.126.1.2
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Enormous steps have been taken in the care of patients with acute myocardial infarction (AMI). Specifically, the advent of early reperfusion with either thrombolytic therapy or primary angioplasty has resulted in mortality reduction and the preservation of ventricular function in patients presenting with ST-elevation myocardial infarction (STEMI).13 Although it is clear that early reperfusion may lead to better survival in patients with STEMI, a significant number of patients arrive at the hospital beyond the window of opportunity (ie, ≤ 12 h after symptom onset) for effective acute reperfusion therapy.4 Therefore, further improvements in the outcomes of AMI patients may be limited by delays in the patient’s arrival at the hospital or by delays in the reaction time of the treating hospitals (ie, door-to-lytic therapy time or door-to-balloon time).,47 In addition, the optimal management for STEMI patients who present to the hospital late in the course of their myocardial infarction remains uncertain.

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