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ESC policy statement: reperfusion therapy in ST-segment elevation myocardial infarction

The European Society of Cardiology ( ESC ) has published in the European Heart Journal a policy statement on reperfusion therapy in ST-segment elevation myocardial infarction ( STEMI ).

According to ESC, a clinician may utilise various types of reperfusion, including thrombolytic treatment, percutaneous coronary intervention ( PCI ), or a combination thereof.

Despite this, the paper notes that many countries do not sufficiently implement reperfusion therapy, and as a result, many patients with STEMI do not receive such therapy. For this reason, the ESC decided to review pharmacological and mechanical reperfusion strategies to identify obstacles and find solutions for its implementation.

During a two-day policy conference in June 2005, opinion leaders involved in reperfusion therapy gathered to discuss this issue.
From this policy conference, opinion leaders came up with several messages for the cardiology community:

- 1. The main objective to achieve at least 75% of reperfusion therapy within the shortest time possible is attainable.

- 2. Practical organisation of reperfusion through regional and national networks must be detailed, with the precise role of each participant detailed and agreed upon.

- 3. Protocols must be written and agreed upon with regard to the type of reperfusion to be offered to patients in order to regulate the administration of reperfusion therapy within a network.

- 4. Early diagnosis of STEMI is essential for timely initiation of therapy – every effort must be made to shorten delays.

- 5. Primary PCI is the preference for reperfusion therapy, as long as it can be delivered by an experienced staff, preferably in a high-volume centre within a reasonable amount of time following first medical contact.

- 6. If primary PCI cannot be delivered in a timely manner, thrombolytic treatment is a valid option particularly within the first three hours after onset of symptoms ( pre-hospital thrombolysis preferred over in-hospital thrombolysis ). Thrombolysis is not the end of reperfusion therapy and may be followed by intervention whenever necessary.

- 7. Physicians in charge of managing STEMI patients must receive information to help them understand the need to shorten delays and to sometimes abandon practices that can undermine access to reperfusion.

- 8. Quality control is imperative and must be implemented to monitor the efficacy of a reperfusion network.

- 9. Public information is also important, as many times patients cause their own delays between onset of symptoms and start of reperfusion therapy in seeking medical attention.

- 10. To ensure that treatment of infarction receives the attention it deserves, politicians and health authorities should be informed about the need to organise networks of reperfusion therapy at regional and national levels.

- 11. The ESC must make every effort to ensure that messages from this policy conference are received at regional and national levels so that proposed strategies and recommendations are implemented.

Source: European Society of Cardiology, 2005