STEMI management: trials, registries, and the real world
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Primary angioplasty (P-PCI) is the preferred treatment of patients with ST-segment elevation myocardial infarction (STEMI) in both American and European guidelines. The reason for this preference is the evidence that the mechanical approach improves coronary patency, TIMI-flow rates and ultimately the overall survival.
Nevertheless, P-PCI has its own drawbacks: it needs skill and must be delivered in a timely fashion (two contrasting requirements, in that skill is linked to activity volume which, in turn, decreases along with catheterization laboratories proliferation); not to mention the costs.
So far, in no single study has P-PCI been shown to reduce mortality, a goal whose achievement has been suggested only in an overview of small trials. Moreover, the advantage fades when P-PCI is compared with contemporary lytic regimens .
Therefore, it may be asked whether this apparent small advantage of P-PCI may be generalized to the real world. Indeed, it has been recognized for a long...
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