The full content of Annals is available to subscribers

Subscribe/Learn More  >
Reviews |

Narrative Review: Reperfusion Strategies for ST-Segment Elevation Myocardial Infarction

Henry H. Ting, MD, MBA; Eric H. Yang, MD; and Charanjit S. Rihal, MD, MBA
[+] Article, Author, and Disclosure Information

From Mayo Clinic College of Medicine, Rochester, Minnesota.

Grant Support: None.

Potential Financial Conflicts of Interest: In the past, Drs. Ting and Rihal have received grants from and Dr. Rihal has consulted for Millennium Pharmaceuticals. None of the authors have active potential financial conflicts.

Requests for Single Reprints: Charanjit S. Rihal, MD, MBA, Cardiac Catheterization Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905; e-mail, rihal@mayo.edu.

Current Author Addresses: Drs. Ting, Yang, and Rihal: Cardiac Catheterization Laboratory, Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905.

Ann Intern Med. 2006;145(8):610-617. doi:10.7326/0003-4819-145-8-200610170-00010
Text Size: A A A

Optimal treatment for ST-segment elevation myocardial infarction depends on early diagnosis and rapid selection of the appropriate reperfusion strategy. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy at PCI-capable hospitals. For hospitals without PCI capability, there are 2 reperfusion strategies, primary PCI and thrombolytic therapy, which are both supported by clinical evidence and national guidelines. Transferring patients for primary PCI may cause delays and requires established, proven protocols, systems, and networks to achieve minimal door-to-balloon times. The authors review the available data and present a systematic, evidence-based approach in a simple framework to enable noncardiovascular and cardiovascular physicians to select the optimal reperfusion strategy. The framework is based on available data from clinical trials and local circumstances from clinical practice by incorporating duration of symptoms (fixed ischemia time) and anticipated transport delays to a PCI-capable facility (incurred ischemia time).


Grahic Jump Location
Algorithm for selecting a management strategy in patients with ST-segment elevation myocardial infarction (STEMI).

PCI = percutaneous coronary intervention.

Grahic Jump Location




CME Activities are only available to ACP members and Individual Annals subscribers. If you are a member or a subscriber please sign in. Otherwise please become a member or subscribe to Annals.
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


Submit a Comment/Letter
Submit a Comment/Letter

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.


Buy Now for $32.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.