Author + information
- Christian Juhl Terkelsen, MD, PhD* (, )
- Jacob Thorsted Sørensen, MD and
- Torsten Toftegaard Nielsen, MD, DmSc
- ↵*Department of Cardiology B, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
We thank Drs. Vasaiwala and Vidovich for their interest in our recent viewpoint (1). Their observations from http://www.hospitalcompare.hhs.gov/document that many patients are still given in-hospital fibrinolysis at unacceptable long door-to-needle (D2N) times. We agree that the wording in the 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of patients with ST-Segment Elevation Myocardial Infarction (STEMI) (2) may be prohibitive for a primary percutaneous coronary intervention (PCI) strategy and in some scenarios favors a fibrinolytic strategy. We still hope that the writing committee responsible for the updated STEMI guidelines for future revisions accepts that: 1) primary PCI is superior to fibrinolysis up to a PCI-related delay of 120 min; 2) the clock should start ticking at the same time when balancing primary PCI against fibrinolysis as the choice of reperfusion strategy; 3) pre-hospital diagnosis is important irrespective of reperfusion strategy to ensure either pre-hospital fibrinolysis or pre-hospital rerouting to high-volume PCI centers; and 4) in-hospital fibrinolysis should only be considered in self-presenters at rural hospitals without easy access to a PCI center. We would also recommend that the committee responsible for the ACC/AHA Performance Measures for Adults With STEMI/NSTEMI consider system delay as a future performance measure and recommend fibrinolysis only if the expected system delay when performing primary PCI is more than 120 min longer than expected system delay when giving fibrinolysis (3).
- American College of Cardiology Foundation
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- Sørensen J.T.,
- Nielsen T.T.
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