Herz
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The extent of myocardial damage occurring during acute myocardial infarction is time dependent, and there is abundant evidence from most clinical trials that mortality reduction is greatest in patients treated early with thrombolytic agents, although beneficial effects have been shown with treatment initiated up to 12 hours after onset of symptoms. This temporal dependence of benefit was most clearly seen with the 47% mortality reduction obtained with streptokinase given within the first hour in the GISSI-1 trial (Table 1). The process of infarction may be completely aborted if reperfusion is initiated within 30 minutes after symptom onset. ⋯ The paramedics then obtained a computer-interpreted ECG which was transmitted to the emergency department in the hospital where a physician made the decision on the form of treatment. The thrombolytic agent was then administered by the paramedic. In the European Myocardial Infarction Project (EMIP) an emergency physician was personally present and responsible in the prehospital setting, whereas in the Grampian Region Early Anistreplase Trial (GREAT) general practitioners made the decision for enrolling the patient.
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Cardiogenic shock in acute myocardial infarction patients is the most common cause of in-hospital death. Various studies showed, that 60 to 100% of patients in cardiogenic shock will die, if no early reperfusion of their coronary artery could be established. The incidence of cardiogenic shock has decreased during the last years, most likely due to early thrombolytic therapy and administration of nitroglycerin. ⋯ Results of early surgery in papillary muscle rupture or ventricular septal defects are much better than delayed interventions. Rupture of the free wall is usually a fatal event. In summary, the most successful therapy of cardiogenic shock is early emergency PTCA.(ABSTRACT TRUNCATED AT 400 WORDS)