Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Mar 2004
Review[Angioplasty or fibrinolytic therapy in acute myocardial infarction with ST elevation?].
Early and complete opening of the thrombotic occluded coronary artery is the best treatment of acute myocardial infarction with ST-segment elevation in ECG. Mechanical reperfusion with coronary angioplasty and pharmacological opening with fibrinolytic drugs are alternative therapies. Primary coronary angioplasty is the best therapy in hospitals with the necessary facilities, giving lower mortality, less reinfarction and stroke. ⋯ The patient should be given analgesics and acetylsalicylic acid before transport to hospital. The value of prehospital fibrinolytic therapy and the use of glucoprotein IIb/IIIa receptor inhibitors before transport are disputed. After failed fibrinolytic treatment, rescue angioplasty can be done with good outcomes.
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In Norway, every year more than 3000 persons suffer sudden cardiac death caused by ventricular fibrillation. The present recommendations of international expert committees are that the use of public-access defibrillators should be encouraged, including training of non-medical personnel. ⋯ Application of the strategy of public-access defibrillators will not result in significantly improved survival from cardiac arrest in Norway.