Reducing mortality in myocardial infarction -- Townend and Doshi 330 (7496): 856 -- BMJ

Reducing mortality in myocardial infarction -- Townend and Doshi 330 (7496): 856 -- BMJ: "Treatment in specialised angioplasty centres should follow rapid prehospital thrombolysis

Restoring blood flow promptly in an occluded coronary artery by either thrombolysis or angioplasty reduces mortality in myocardial infarction with ST elevation. With both treatments, the faster reperfusion is achieved, the greater the reduction in mortality.1 2 The relative merits of thrombolysis in hospital and angioplasty have recently been debated in this journal,3 4 but in most developed countries the debate is largely over. Meta-analysis of trials comparing the two treatments showed a reduction in reinfarction and stroke and a small reduction in mortality in favour of angioplasty. 5 Guidelines from the European Society of Cardiology now state that primary angioplasty is the preferred therapeutic option when it can be performed 'within 90 minutes after the first medical contact.'6

In the United Kingdom no special funding exists for primary angioplasty: thrombolysis in hospital remains the standard treatment. Things may be about to change, however. The Department of Health has earmarked 1m ($1.89m; {euro}1.46m) 'to pilot the possibility of providing a national 24/7 primary angioplasty service,' even though such a service would require enormous reorganisation of services and considerable additional investment. Patients with acute myocardial infarction would bypass their local hospitals and go to specialist centres providing a 24 hour angioplasty service. This proposal entails daunting logistical and financial challenges, and the prospect of large numbers of emergency procedures, many of them performed out of hours, raises questions about the quality of such a service."