Universal reperfusion therapy can be implemented: Lessons from 20 years of management of patients admitted within 6 hours of symptom onset with ST-segment elevation acute myocardial infarction

Summary Aim To describe longitudinal trends in patients’ characteristics, management and hospital outcomes over 20 years of therapy for ST-segment elevation myocardial infarction (STEMI). Methods From 1988 to 2007, 2100 consecutive patients with STEMI were admitted within 6 hours of symptom onset to a centre with a systematic reperfusion policy. The population was divided into three periods 1988–1996, 1996–2001 and 2001–2007. Results The baseline risk of mortality increased over time ( p  = 0.02). Use of primary PCI increased and the proportion not receiving reperfusion therapy decreased (from 11.4 to 4.2%, p  = 0.0001). Adjunctive use of stents and glycoprotein IIb/IIIa antagonists increased. The proportion of patients achieving acute TIMI-3 flow in the infarct artery increased (81 to 92%, p  = 0.001), while time from symptom onset to reperfusion decreased (240 to 205 min, p p p  = 0.18). Conclusion Reperfusion therapy can be implemented in up to 96% of STEMI patients admitted within 6 hours of symptom onset and this is associated with improvements in outcomes. Further improvements are needed in the management of patients with cardiogenic shock.