Читать книгу Interventional Cardiology - Группа авторов - Страница 311

The evidence to date is overwhelming in favor of immediate reperfusion as the most effective strategy for treatment of STEMI [1,2]. Primary PCI and thrombolysis represent the main reperfusion strategies. Most recent European Society of Cardiology (ESC) guidelines express a preference for primary PCI as the preferred method of reperfusion, with the caveat that it is performed in a timely manner by an experienced team [3]. Similarly American College of Cardiology Foundation/American Heart Association (ACCF/AHA) guidelines recommend that “primary PCI of the infarct related artery is preferred to fibrinolytic therapy when time‐to‐treatment delays are short and the patient presents to a high‐volume, well‐equipped center with experienced interventional cardiologists and skilled support staff” [4]. A “timely manner” is defined as the performance of primary PCI within 12 h of symptom onset, and within 120 min from STEMI diagnosis [3]. This target is best achieved by regional networks, consisting of a referral PCI center (hub) and non‐PCI centers (spokes), linked by an effective emergency medical system. Such regional networks appear to perform best when covering an area comprising a population of approximately 0.5 million people. Where possible, pre‐hospital diagnosis should be implemented, and patients transferred immediately to the cath lab, bypassing delays associated with initial assessment of patients in the Emergency Department or Cardiac Intensive Care Unit respectively, of up to 20–40 mins in each case [5].