EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology
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The Stent for Life Initiative was founded in September 2008 as a coalition of the European Society of Cardiology, European Association for Percutaneous Cardiovascular Interventions and Eucomed. The aim is to promote the life-saving indications for percutaneous coronary interventions--especially in all forms of acute myocardial infarction. This article describes how this initiative began.
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Review Meta Analysis Comparative Study
The transradial versus the transfemoral approach for primary percutaneous coronary intervention in patients with acute myocardial infarction: a systematic review and meta-analysis.
There is an increasing amount of data suggesting that transradial approach is associated with lower incidence of complications in vascular access site and improved clinical outcomes compared with transfemoral approach in the setting of ST-segment elevation myocardial infarction (STEMI). The objective of this study was to assess the safety and efficacy of radial versus femoral percutaneous coronary intervention (PCI) for patients with STEMI. ⋯ This updated meta-analysis demonstrates that transradial PCI reduces the risk of significant periprocedural bleeding and improve clinical outcomes in patients with STEMI.
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In remote, sparsely populated areas with long transfer distances to percutaneous coronary intervention (PCI) centres it is impossible to deliver PCI within the recommended time limits, and fibrinolysis should be the treatment of choice in patients with ST-elevation myocardial infarction (STEMI). Fibrinolysis should preferably be administered in the pre-hospital setting. Patients with contraindications to fibrinolysis, late presenters and patients with cardiogenic shock should be transferred for primary PCI, even when the transfer delays are substantial. ⋯ The optimal timing of routine angiography following fibrinolysis is not settled, but recent trials suggest a time window of two to 12 hours. A well-organised system of care with clear treatment protocols and coordinated transfer systems is necessary for identifying treatment-eligible patients for on-site fibrinolysis or transfer for primary PCI, and for ensuring that therapies are available in a timely manner 24 hours a day, seven days a week. A well-organised STEMI network is also necessary for early transfer of lytic treated patients for rescue PCI or routine angiography.
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Primary percutaneous coronary intervention (PPCI) is the recommended treatment for patients with acute ST-segment elevation myocardial infarction (STEMI). A survey conducted in 2008 in the European Society of Cardiology (ESC) countries reported that the annual incidence of hospital admissions for acute STEMI is around 800 patients per million inhabitants. The survey also showed that STEMI patients' access to reperfusion therapy and the use of PPCI or thrombolytic therapy (TT) vary considerably among countries. ⋯ Furthermore, studies on potential factors or characteristics that explain the national penetration of PPCI are needed. Such knowledge will be necessary to increase the effectiveness and efficiency of the implementation, and will be the first step in ensuring equal access to PPCI treatment for STEMI patients in Europe. Establishing the delivery of PPCI in an effective, high-quality and timely manner is a great challenge.