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Prehospital thrombolysis expansion may raise the rate of its inappropriate administration in ST-elevation acute myocardial infarction induced by aortic dissection

Published:February 04, 2013DOI:https://doi.org/10.1016/j.ajem.2012.12.022
      Acute myocardial infarction (AMI) is major cause of death worldwide. Coronary heart disease alone caused ≈1 of every 6 deaths in the United States in 2009 [
      • Go A.S.
      • Mozaffarian D.
      • Roger V.L.
      • et al.
      Heart Disease and Stroke Statistics—2013 update a report from the American Heart Association.
      ]. Each year, an estimated ≈635000 Americans have a new coronary attack (defined as first hospitalized MI or coronary heart disease death) [
      • Go A.S.
      • Mozaffarian D.
      • Roger V.L.
      • et al.
      Heart Disease and Stroke Statistics—2013 update a report from the American Heart Association.
      ]. ST-elevation AMI (STEMI) accounts for 30% of acute coronary syndromes [
      • Hiscock M.
      Percutaneous coronary intervention or prehospital thrombolysis? What is the preferred treatment in S-T elevation myocardial infarction?.
      ]. The treatment of choice for STEMI is primary percutaneous coronary intervention (PPCI)—if available quickly. The disadvantages of PPCI are high costs for the equipment, need for number of excellent invasive cardiologists and very good organization, and, thus, relative lack of 24/7 availability as well as relatively long time from the first medical contact to reperfusion (which is rarely achieved within 2 hours of symptoms) [
      • Hiscock M.
      Percutaneous coronary intervention or prehospital thrombolysis? What is the preferred treatment in S-T elevation myocardial infarction?.
      ].
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