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Chapter 1

The Thrombotic AMI Lesion: Lessons from Pathology more...

Chapter 2

Electrocardiographic Identification of the Culprit Lesion in ST-Segment Elevation Myocardial more...

Chapter 3

The Role of Thrombolysis in the Era of STEMI Interventions more...

Chapter 4

STEMI Interventions: A Review of Relevant Clinical Trials more...

Chapter 5

Updated Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction more...

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Chapter 3
The Role of Thrombolysis in the Era of STEMI Interventions
Amit Kumar, MD and Christopher P. Cannon, MD

Introduction and General Concepts
Numerous randomized clinical trials over the last two decades have provided evidence regarding importance of the “open artery theory” in patients with ST-segment elevation myocardial infarction (STEMI). This theory holds that prompt and complete restoration of flow in the infarct-related artery (IRA) after the onset of symptoms leads to increased myocardial salvage, reduced left ventricular (LV) dysfunction and improved survival. There are two strategies currently available for establishing timely coronary reperfusion – pharmacologic (thrombolysis) and mechanical (primary percutaneous coronary intervention [PCI]). The American College of Cardiology/American Heart Association (ACC/AHA) STEMI guidelines recommend that all STEMI patients should undergo rapid evaluation for reperfusion therapy and have a reperfusion strategy implemented promptly after contact with the medical system, with a goal of door-to-needle (or first medical contact-to-needle) time for initiation of fibrinolytic therapy ≤ 30 minutes and door-to-balloon (DTB) (or first medical contact-to-balloon) time for PCI ≤ 90 minutes.

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