Previous studies have shown that an important gap still exists between the clinical performance of timely reperfusion therapy
and the guideline-recommended timing for patients with STEMI.
A targeted neurological (National Institute of Health Stroke Score (NIHSS)) and cardiovascular examination and rapid blood glucose test should be performed before the start of reperfusion therapy
. Further work-up, including blood investigations, an electrocardiogram (ECG) and a chest radiograph, should not delay treatment.
The proposed time windows system goal, for any individual patient every effort should be made to provide reperfusion therapy
as rapidly as possible.
For predicting high-risk stratification and reperfusion therapy
, the qSOFA-ECG is superior to PE Severity Index (PESI) and simplified PESI.
Measurements on admission (baseline) were not taken in this group as they delay reperfusion therapy
. Mean difference among measurement of MPI was highest between discharge and six-month interval.
de Winter and Wellens pointed out the importance of recognizing the equivalents of acute MI with ST elevation and need for emergency reperfusion therapy
. After analyzing data obtained from the database of PCIs, ECG on the first contact with the patient, ECG before treatment, findings of coronary angiography, they described ECG pattern found in approximately 2% of patients with angiography proven anterior MI with occlusion of the anterior descending coronary artery .
If reperfusion therapy
is not appropriate, then the focus is on management to minimize further damage from the stroke, decrease the likelihood of recurrence, and lessen secondary problems related to the stroke.
While reperfusion therapy
has brought new hope for the reduction of myocardial damage, reperfusion itself has been shown to potentially induce a localized oxidative burst and a regional inflammatory response, resulting in cell damage and, in some cases, death.
More recent data using propensity scores to compare reperfusion therapy
to anticoagulation alone found no significant difference in mortality and bleeding, with a higher risk of recurrence with reperfusion therapy
Multimodal MRI imaging techniques have been shown to better identify patients that are likely to benefit from endovascular reperfusion therapy
. Particularly patients with a significant perfusion/diffusion mismatch on MRI have substantial salvageable brain tissue that can be recovered from ischemia after reperfusion by endovascular treatment, showing better long-term clinical outcome .
with Rapamycin Reduces Infarct Size and Improves Cardiac Function.