CMAJ • May 24, 2005; 172 (11). doi:10.1503/cmaj.1050045.
© 2005 CMA Media Inc. or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Armstrong, P. W.
Right arrow Articles by O'Neill, B. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Armstrong, P. W.
Right arrow Articles by O'Neill, B. J.
Related Collections
Right arrow Ischemic heart disease

Letters
Correspondance

Guidelines for STEMI

Paul W. Armstrong*, Peter Bogaty{dagger}, Christopher E. Buller{ddagger} and Blair J. O'Neill§

Department of Medicine, University of Alberta, Edmonton, Alta.;* Quebec Heart Institute, Laval Hospital, Sainte-Foy, Que.;{dagger} Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC;{ddagger} Department of Medicine, Dalhousie University, Halifax, NS§

Although Warren Cantor and Laurie Morrison suggest that primary PCI may be superior to fibrinolysis, the converse may be true in the early hours after symptom onset, and this remains an important and unresolved issue.1,2 Facilitated PCI should encompass a broader definition than prior fibrinolytic therapy alone, as articulated in the recent guidelines: "Facilitated PCI refers to a strategy of planned immediate PCI after an initial pharmacologic regimen such as full dose fibrinolysis, half dose fibrinolysis, a GP [glycoprotein] IIb/IIIa inhibitor or a combination of reduced dose fibrinolytic therapy in a platelet GP IIb/IIIa inhibitor."3

We commend Cantor and Morrison for their involvement in the TRANSFER-AMI study and await with interest its results, as well as those of the large ASSENT IV (Assessment of the Safety and Efficacy of a New Treatment Strategy for Acute Myocardial Infarction) and FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) studies, as they relate to the issue of facilitated PCI.4 If these studies demonstrate positive results, it will be important to consider the resource implications and ensure, at a minimum, the targeting of high-risk patients.

Cathal O'Donnell and Richard Verbeek opine that we have not considered the challenges for emergency services related to achieving a 60-minute transfer for PCI. Unfortunately, CMAJ space restrictions precluded discussion of this issue in our case-based report,5 but our broader discussion of the topic has recently been published elsewhere.1 We agree that enhancement of EMS should occur pari passu with enhanced tertiary and quaternary care for such patients. For maximal resource efficiency, we believe that the STEMI algorithm in Fig. 2 of our CMAJ article5 provides a useful destination template.

Footnotes

Competing interests: None declared for Drs. Bogaty and O'Neill. Dr. Armstrong has received research funding from Hoffmann–La Roche, Aventis and Boehringer Ingelheim, and educational and consultant funding from Hoffmann–La Roche and Aventis. Dr. Buller has received research support from Guidant Corp. and Cordis Johnson & Johnson, consultant fees from Guidant Corp. and Aventis, and speaker fees from Hoffman–La Roche.


References

  1. Armstrong PW, Bogaty P, Buller CE, Dorian P, O'Neill BJ. The 2004 ACC/AHA guidelines: a perspective and adaptation for Canada by the Canadian Cardiovascular Society Working Group. Can J Cardiol 2004;20(11):1075-9.[Medline]
  2. Steg PG, Bonnefoy E, Chabaud S, Lapostolle F, Dubien PY, Cristofini P, et al; Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) Investigators. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 2003;108(23):2851-6.[Abstract/Free Full Text]
  3. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. Circulation 2004;110:588-636.[Free Full Text]
  4. Welsh RC, Armstrong PW. A marriage of enhancement: fibrinolysis and conjunctive therapy. Thromb Haemost 2004;92:1194-200.[Medline]
  5. Bogaty P, Buller CE, Dorian P, O'Neill BJ, Armstrong PW. Applying the new STEMI guidelines: 1. Reperfusion in acute ST-segment elevation myocardial infarction. CMAJ 2004;171(9):1039-41.[Free Full Text]




This Article
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Armstrong, P. W.
Right arrow Articles by O'Neill, B. J.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Armstrong, P. W.
Right arrow Articles by O'Neill, B. J.
Related Collections
Right arrow Ischemic heart disease