Angioplasty For Myocardial Infarction Research Articles

A randomized trial of transfer for primary angioplasty versus on-site thrombolysis in patients with high-risk myocardial infarction: The air primary angioplasty in myocardial infarction study

ObjectivesThe Air Primary Angioplasty in Myocardial Infarction (PAMI) study was designed to determine the best reperfusion strategy for patients with high-risk acute myocardial infarction (AMI) at hospitals without percutaneous transluminal coronary angioplasty (PTCA) capability. BackgroundPrevious studies have suggested that high-risk patients have better outcomes with primary PTCA than with thrombolytic therapy. It is unknown whether this advantage would be lost if the patient had to be transferred for PTCA, and reperfusion was delayed. MethodsPatients with high-risk AMI (age >70 years, anterior MI, Killip class II/III, heart rate >100 beats/min or systolic BP <100 mm Hg) who were eligible for thrombolytic therapy were randomized to either transfer for primary PTCA or on-site thrombolysis. ResultsOne hundred thirty-eight patients were randomized before the study ended (71 to transfer for PTCA and 67 to thrombolysis). The time from arrival to treatment was delayed in the transfer group (155 vs. 51 min, p < 0.0001), largely due to the initiation of transfer (43 min) and transport time (26 min). Patients randomized to transfer had a reduced hospital stay (6.1 ± 4.3 vs. 7.5 ± 4.3 days, p = 0.015) and less ischemia (12.7% vs. 31.8%, p = 0.007). At 30 days, a 38% reduction in major adverse cardiac events was observed for the transfer group; however, because of the inability to recruit the necessary sample size, this did not achieve statistical significance (8.4% vs. 13.6%, p = 0.331). ConclusionsPatients with high-risk AMI at hospitals without a catheterization laboratory may have an improved outcome when transferred for primary PTCA versus on-site thrombolysis; however, this will require further study. The marked delay in the transfer process suggests a role for triaging patients directly to specialized heart-attack centers.

The salutary effect of prior beta blocker therapy on clinical outcomes following primary angioplasty for acute myocardial infarction: a pooled analysis from the Primary Angioplasty in Myocardial Infarction (PAMI:1), PAMI:2, and stent:PAMI trials

The salutary effect of prior beta blocker therapy on clinical outcomes following primary angioplasty for acute myocardial infarction: a pooled analysis from the Primary Angioplasty in Myocardial Infarction (PAMI:1), PAMI:2, and stent:PAMI trials

Angiographic and clinical characteristics associated with increased in-hospital mortality in elderly patients with acute myocardial infarction undergoing percutaneous intervention (a pooled analysis of the primary angioplasty in myocardial infarction trials)

Advanced age is associated with increased mortality in acute myocardial infarction (AMI) but the mechanism remains unclear. We performed a pooled analysis of 3,032 patients from the Primary Angioplasty in Myocardial Infarction (PAMI)-2, Stent-PAMI, and PAMI-No Surgery On Site trials to determine which clinical, hemodynamic, and angiographic characteristics in the elderly were associated with in-hospital death. There were 452 patients aged ≥75 years and 2,580 patients aged <75 years. Older patients had a lower number of risk factors for coronary artery disease but more comorbidities. Acute catheterization demonstrated more 3-vessel disease, higher left ventricular (LV) end-diastolic pressure, lower LV ejection fraction, and higher initial rates of Thrombolysis In Myocardial Infarction (TIMI) trial 2 or 3 flow. Elderly patients were equally likely to undergo percutaneous intervention but had a lower procedural success rate and lower rates of final TIMI 3 flow, and older patients were more likely to have post-AMI complications. In-hospital mortality was 10.2% and 1.8%, respectively (p = 0.001). Cardiac and noncardiac mortality was higher in elderly patients, and no significant differences in causes of death were identified. Multivariate analysis revealed that the strongest predictors of death were age ≥75 years, lower LV ejection fraction, lower final TIMI flow, higher Killip class, need for an intra-aortic balloon pump (IABP), and post-AMI stroke/transient ischemic attack, or significant arrhythmia. Despite avoiding thrombolysis, elderly patients remain at increased risk of bleeding, stroke, and other post-AMI complications, and death. Cardiac risk factor analysis and acute catheterization offer prognostic information but do not completely explain the mechanism of increased in-hospital mortality in the elderly.

Diabetes mellitus and outcome after primary coronary angioplasty for acute myocardial infarction: lessons from the GUSTO-IIb angioplasty substudy

OBJECTIVESWe sought to compare the efficacy of primary angioplasty in diabetics versus nondiabetics and to evaluate the relative benefits of angioplasty over thrombolytic therapy among diabetics.BACKGROUNDPrimary angioplasty for myocardial infarction is at least as effective as thrombolytic therapy in the general population. However, the influence of diabetic status on outcome after primary angioplasty versus thrombolysis remains unknown.METHODSPatients in the Global Use of Strategies To Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) Angioplasty Substudy were randomized to receive either primary angioplasty or accelerated alteplase. The interaction of diabetic status (diabetics n = 177, nondiabetics n = 961) and treatment strategy with the occurrence of the primary end point (death, nonfatal reinfarction or nonfatal, disabling stroke at 30 days) was analyzed (power to detect a 40% relative reduction in the primary end point with alpha = 0.05 and beta = 0.20). Among patients who were randomized to and underwent primary angioplasty, procedural success (defined as residual stenosis <50% and TIMI grade 3 flow) was assessed based on diabetic status.RESULTSCompared with nondiabetics, diabetics had worse baseline clinical and angiographic profiles. Despite more severe stenosis and poorer flow in the culprit artery, procedural success with angioplasty was similar for diabetics (n = 81; 70.4%) and nondiabetics (n = 391; 72.4%). Outcome at 30 days was better for nondiabetics randomized to angioplasty versus alteplase (adjusted odds ratio, 0.62; 95% confidence interval, 0.41–0.96) with a similar trend for diabetics (0.70, [0.29–1.72]). We noted no interaction between diabetic status and treatment strategy on outcome (p = 0.88).CONCLUSIONSPrimary angioplasty was similarly successful in diabetics and nondiabetics and appeared to be more effective than thrombolytic therapy among diabetics with acute infarction.

Critical pathways : a review. Committee on Acute Cardiac Care, Council on Clinical Cardiology, American Heart Association.

Critical pathways, also known as critical paths, clinical pathways, or care paths, are management plans that display goals for patients and provide the sequence and timing of actions necessary to achieve these goals with optimal efficiency.1 As competition in the healthcare industry has increased, managers have embraced critical pathways as a method to reduce variation in care, decrease resource utilization, and potentially improve healthcare quality. Cardiovascular medicine in particular is an area in which critical pathways have been embraced. This is due in part to the high volume and high cost associated with cardiovascular diseases and procedures. In addition, the relatively mature guideline process has also contributed to the growth in use of critical pathways in cardiology. Although anchored in clinical guidelines, the critical pathway is a distinct tool that details processes of care and highlights inefficiencies regardless of whether there is evidence to warrant changes in those processes. Clinical guidelines, on the other hand, are consensus statements that are systematically developed to assist practitioners in making patient management decisions related to specific clinical circumstances.2 Although clinical guidelines can and should be used in pathway development, the majority of processes included in a pathway have not been rigorously tested and are generally not addressed in guidelines. Another term that should also be distinguished from critical pathways is clinical protocols. Protocols are treatment recommendations that are often based on guidelines. Like the critical pathway, the goal of the clinical protocol may be to decrease treatment variation. However, protocols are most often focused on guideline compliance rather than the identification of rate-limiting steps in the patient care process. In further contrast to critical pathways, protocols may or may not include a continuous monitoring and data-evaluation component. Critical pathway techniques were first developed for use in industry as a tool to …

Local intramural heparin delivery during primary angioplasty for myocardial infarction: Results of the local PAMI pilot study

Local intramural heparin delivery during primary angioplasty for myocardial infarction: Results of the local PAMI pilot study

Coronary stenting during rescue angioplasty after failed thrombolysis.

Compared with primary angioplasty [percutaneous transluminal coronary angioplasty (PTCA)], rescue PTCA is associated with lower angiographic success and higher reocclusion rates, especially after thrombolysis with tissue-type plasminogen activator (tPA). Although stent placement during primary PTCA has been demonstrated to be safe and even to improve the angiographic results achieved by balloon-alone PTCA, there are few data on stent placement during rescue PTCA after failed thrombolysis. This study sought to assess the feasibility and safety of stent implantation during rescue angioplasty in myocardial infarction after failed thrombolysis. The study population consisted of 20 patients with acute myocardial infarction referred for rescue PTCA after failed thrombolysis consecutively treated with coronary stenting. The thrombolytic agent was tPA in 15 patients (75%), streptokinase in 1 (5%), and anisoylated streptokinase plasminogen activator complex (APSAC) in 1 (5%); 3 patients (15%) were included in the INTIME II study (tPA vs. lanoteplase). After stenting, aspirin 200 mg daily plus ticlopidine 250 mg b.i.d. were administered. Thirty stents (1.5+/-1.0 per patient) were implanted. Angiographic success was achieved in 19 patients (95%). Two patients (10%) died, both because of severe bleeding complications. One patient (5%) suffered a reinfarction, but no patients suffered postinfarction angina or needed new target vessel revascularization. Eighteen patients (90%) were discharged alive and free of events. All these patients remained asymptomatic and free of target vessel revascularization at 6-month follow-up. Stent placement during rescue PTCA after failed thrombolysis is feasible and safe and is associated with a good angiographic result and clinical outcome. Bleeding complications seem to be, however, the main limitation of this reperfusion strategy.

Long-term outcome after primary angioplasty: report from the Primary Angioplasty in Myocardial Infarction (PAMI-I) trial

OBJECTIVESThis study sought to compare the two-year outcome after primary percutaneous coronary angioplasty or thrombolytic therapy for acute myocardial infarction.BACKGROUNDPrimary angioplasty, that is, angioplasty without antecedent thrombolytic therapy, has been shown to be an effective reperfusion modality for patients suffering an acute myocardial infarction. This report reviews the two-year clinical outcome of patients randomized in the Primary Angioplasty in Myocardial Infarction trial.METHODSAt 12 clinical centers, 395 patients who presented within 12 h of the onset of myocardial infarction were randomized to undergo primary angioplasty (195 patients) or to receive tissue-type plasminogen activator (t-PA) (200 patients) followed by conservative care. Patients were followed by physician visits, phone call, letter and review of hospital records for any hospital admission at one month, six months, one year and two years.RESULTSAt two years, patients undergoing primary angioplasty had less recurrent ischemia (36.4% vs. 48% for t-PA, p = 0.026), lower reintervention rates (27.2% vs. 46.5% for t-PA, p < 0.0001) and reduced hospital readmission rates (58.5% vs. 69.0% for t-PA, p = 0.035). The combined end point of death or reinfarction was 14.9% for angioplasty versus 23% for t-PA, p = 0.034. Multivariate analysis found angioplasty to be independently predictive of a reduction in death, reinfarction or target vessel revascularization (p = 0.0001).CONCLUSIONSThe initial benefit of primary angioplasty performed by experienced operators is maintained over a two-year follow-up period with improved infarct-free survival and reduced rate of reintervention.

Safety and Cost-Effectiveness of Early Discharge After Primary Angioplasty in Low Risk Patients With Acute Myocardial Infarction

Objectives. The second Primary Angioplasty in Myocardial Infarction (PAMI-II) study evaluated the hypothesis that primary percutaneous transluminal coronary angioplasty (PTCA), with subsequent discharge from the hospital 3 days later, is safe and cost-effective in low risk patients.Background. In low risk patients with myocardial infarction (MI), few data exist regarding the need for intensive care and noninvasive testing or the appropriate length of hospital stay.Methods. Patients with acute MI underwent emergency catheterization with primary PTCA when appropriate. Low risk patients (age ≤70 years, left ventricular ejection fraction >45%, one- or two-vessel disease, successful PTCA, no persistent arrhythmias) were randomized to receive accelerated care (admission to a nonintensive care unit and day 3 hospital discharge without noninvasive testing [n = 237] or traditional care [n = 234]).Results. Patients who received accelerated care had similar in-hospital outcomes but were discharged 3 days earlier (4.2 ± 2.3 vs. 7.1 ± 4.7 days, p = 0.0001) and had lower hospital costs ($9,658 ± 5,287 vs. $11,604 ± 6,125 p = 0.002) than the patients who received traditional care. At 6 months, accelerated and traditional care groups had a similar rate of mortality (0.8% vs. 0.4%, p = 1.00), unstable ischemia (10.1% vs. 12.0%, p = 0.52), reinfarction (0.8% vs. 0.4%, p = 1.00), stroke (0.4% vs. 2.6%, p = 0.07), congestive heart failure (4.6% vs. 4.3%, p = 0.85) or their combined occurrence (15.2% vs. 17.5%, p = 0.49). The study was designed to detect a 10% difference in event rates; at 6 months, only a 2.3% difference was measured between groups, indicating an actual power of 0.19.Conclusions. Early identification of low risk patients with MI allowed safe omission of the intensive care phase and noninvasive testing, and a day 3 hospital discharge strategy, resulting in substantial cost savings.

PAMI (primary angioplasty in myocardial infarction) stent pilot trial

PAMI (primary angioplasty in myocardial infarction) stent pilot trial

Analysis of the Relative Costs and Effectiveness of Primary Angioplasty Versus Tissue-Type Plasminogen Activator: The Primary Angioplasty in Myocardial Infarction (PAMI) Trial

Objectives. We sought to determine the relative cost and effectiveness of two different reperfusion modalities in patients with acute myocardial infarction (AMI).Background. Recent studies have found superior clinical outcomes after reperfusion by primary percutaneous transluminal coronary angioplasty (PTCA) compared with thrombolytic therapy. The high up-front costs of cardiac catheterization may diminish the relative advantages of this invasive strategy.Methods. Detailed in-hospital charge data were available from all 358 patients with AMI randomized to tissue-type plasminogen activator (t-PA) or primary PTCA in the United States from the Primary Angioplasty in Myocardial Infarction trial. Resource consumption during late follow-up was estimated by assessment of major clinical events and functional status.Results. Compared with t-PA, primary PTCA resulted in reduced rates of in-hospital mortality (2.3% vs. 7.2%, p = 0.03), reinfarction (2.8% vs. 7.2%, p = 0.06), recurrent ischemia (11.3% vs. 28.7%, p < 0.0001) and stroke (0% vs. 3.9%, p = 0.02) and a shorter hospital stay (7.6 ± 3.3 days vs. 8.4 ± 4.7 days, p = 0.04). Despite the initial costs of cardiac catheterization in all patients with the invasive strategy, total mean (±SD) hospital charges were $3,436 lower per patient with PTCA than with t-PA ($23,468 ± $13,410 vs. $26,904 ± $18,246, p = 0.04), primarily due to the reduction in adverse in-hospital outcomes. However, professional fees were higher after primary PTCA ($4,185 ± $3,183 vs. $3,322 ± $2,728, p = 0.001), and thus total charges, although favoring PTCA, were not significantly different ($27,653 ± $13,709 vs. $30,227 ± 18,903, p = 0.21). At a mean follow-up time of 2.1 ± 0.7 years, no major differences in postdischarge events or New York Heart Association functional class were present between PTCA- and t-PA–treated patients, suggesting similar late resource consumption. Including in-hospital events, 83% of PTCA-treated patients were alive and free of reinfarction at late follow-up, compared with 74% of t-PA–treated patients (p = 0.06).Conclusions. Compared with t-PA, reperfusion by primary PTCA improves clinical outcomes with similar or reduced costs. These findings have important clinical implications in an increasingly cost-conscious health care environment.(J Am Coll Cardiol 1997;29:901–7)© 1997 by the American College of Cardiology

Incidence and clinical relevance of the occurrence of bundle-branch block in patients treated with thrombolytic therapy.

Whether thrombolytic therapy alters the incidence and clinical outcome of bundle-branch block is unclear. We examined the occurrence of new-onset bundle-branch block, both transient and persistent, in 681 patients with acute myocardial infarction enrolled in the Thrombolysis and Angioplasty in Myocardial Infarction 9 and Global Utilization of Streptokinase and t-PA for Occluded Arteries 1 protocols. Each patient underwent continuous 12-lead ECG monitoring for 36 to 72 hours with the Mortara ST monitoring system. Bundle-branch block was characterized as right, left, alternating, transient, or persistent. The overall incidence of bundle-branch block was 23.6% (n = 161), with transient block in 18.4% (n = 125) and persistent block in 5.3% (n = 36). Right bundle-branch block was found in 13% (n = 89) of the population; left bundle-branch block was found in 7% (n = 48). Alternating bundle-branch block was seen in 3.5% (n = 24) of patients. Left anterior descending artery infarcts accounted for most bundles (54%, n = 79). Patients with bundle-branch block had lower ejection fractions, higher peak creatine phosphokinase levels (P < .0001), and more diseased vessels (P < .019). Mortality rates in patients with and without bundle-branch block were 8.7% and 3.5%, respectively (P < .007). A higher mortality rate was observed in the presence of persistent (19.4%) versus transient (5.6%) or no (3.5%) bundle-branch block (P < .001). Thrombolytic therapy reduces the overall mortality rate associated with persistent bundle-branch block. However, persistent bundle-branch block remains predictive of a higher mortality rate than either transient or no bundle-branch block. Continuous 12-lead ECG monitoring provides an accurate characterization of the incidence and type of conduction disturbances after acute myocardial infarction.

Effect of reperfusion modality on outcome in nonsmokers and smokers with acute myocardial infarction (a Primary Angioplasty in Myocardial Infarction [PAMI] Substudy)

We analyzed the 395 patients randomized into the Primary Angioplasty in Myocardial Infarction (PAMI) trial to receive tissue plasminogen activator (tPA) or to undergo primary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI). Of these, 168 were current smokers and 128 had never smoked. Univariate analyses of baseline characteristics and outcome, including death, recurrent AMI, and recurrent ischemia, were done by chi-square analysis. Multivariate stratified analysis was then performed controlling for age and gender, which were found to be confounders of outcome. The combined in-hospital outcomes of death, recurrent AMI, and recurrent ischemia were similar for smokers and nonsmokers (p = 0.12). When stratified according to treatment modality, nonsmokers treated with PTCA had a lower frequency of death and nonfatal recurrent AMI (7% vs 18%; p = 0.05), in-hospital ischemia (11% vs 33%; p = 0.004), or the combined event (13% vs 40%; p = 0.001). At 6 months, nonsmokers treated with PTCA continued to have a lower incidence of death or nonfatal recurrent AMI (11% vs 24%; p = 0.07) compared with tPA. Conversely, in smokers, the treatment strategy did not significantly affect hospital outcomes: recurrent ischemia (12% vs 23%; p = 0.07), death and recurrent AMI (6% vs 8%; p = 0.55), or the combined event (15% vs 25%; p = 0.12). The statistical significance of these associations was maintained when multivariate analysis controlling for age and gender was used. Thus, nonsmokers presenting with AMI had a significantly better outcome when treated with primary angioplasty; these differences were not seen in smokers.

Prediction of the Infarct-Related Artery in Acute Myocardial Infarction by a Scoring System Using Summary ST-Segment and T-Wave Changes

We developed a scoring system to predict the artery responsible for an acute myocardial infarction (AMI) using ST-segment and T-wave changes on the initial electrocardiogram (ECG) using data from 228 patients (development set) with symptoms compatible with AMI and tested in a similar group of 223 patients (test set) from the Thrombolysis and Angioplasty in Myocardial infarction (TAMI-5) Trial. Using stepwise logistic regression we were able to accurately predict the left anterior descending (LAD), right, or left circumflex (LC) coronary artery as the infarct-related artery using 2 variables: (1) the summation of the ST-segment elevation in leads V 1 to V 4; and (2) the summation of the T-wave negativity in leads I, aVL, and V 5. In the development set, these 2 variables demonstrated respective sensitivity and specificity of 98% and 90% for LAD lesions, 82% and 85% for right narrowings, and 82% and 84% for LC narrowings. In the test set, the sensitivity and specificity were 97% and 95% for LAD lesions, 85% and 86% for right lesions, and 73% and 60% for LC coronary artery lesions. Information easily obtained on the ECG can accurately predict the likelihood of the LAD, right, or LC artery as the infarct-related artery. This may be useful in the decision to administer thrombolytic treatment. (Am J Cardiol 1996;78:389–395)

Aggressive Intervention for Myocardial Infarction: Angioplasty, Stents, and Intra-aortic Balloon Pumping

Primary percutaneous transluminal coronary angioplasty (PTCA) is not used in all hospitals capable of performing it because the data regarding results are either not known or not easily interpreted. Unlike pharmaceutical trials, which receive $30–50 million in research funds, virtually all trials of PTCA have been unfunded. Nevertheless, several groups have conclusively proved the benefit of primary PTCA over thrombolysis. In a 1995 meta-analysis, PTCA proved superior to thrombolytic therapy in reducing death and reinfarction. The Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-IIB) substudy confirmed this fact with 94% certainty. Other studies were designed to refine the angioplasty technique. In the Primary Angioplasty in Myocardial Infarction (PAMI-I) study, acute catheterization was used to stratify patients and identified a low-risk population whose mortality equaled that of patients treated electively. Compared with clinical risk factors, angiographic findings enhanced the power to predict mortality three-fold. The high-risk subset with acute myocardial infarction (MI) was also randomized to treatment with or without prophylactic intra-aortic balloon pumping (IABP). Although IABP caused no complications, it had no positive effect on primary endpoints (death, recurrent MI, and reocclusion) and did not improve left ventricular function at 6 months. One limitation of primary PTCA is a high rate of late restenosis (30–50% at 6 months). In a pilot study we are examining the role of stents in conjunction with primary PTCA. Early results indicate that in the 69% of patients eligible for stent placement, in-hospital events were uncommon (no deaths, no reinfarctions, low rate of recurrent ischemia) and the need for repeat revascularization was infrequent. (Am J Cardiol 1996;78(suppl 3A):29–34)

The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Trials: A Decade of Reperfusion Strategies

Beginning with its inception in 1985, the TAMI group performed randomized clinical trials in both academic: and nonacademic settings. The ten TAMI trials not only proved the viability of clinical research in a nontraditional environment, but also contributed significantly to the clinical investigation of acute myocardial infarction through small mechanistic trials. Despite having insufficient power to address overall survival and clinical outcome measures because of patient enrollments ranging from only 50–575 patients, the trials used similar entry criteria and follow‐up measures, which permitted broader analyses of the prospectively collected dataset of randomized patients. This article reviews the history of the TAMI collaboration and discusses the findings of the individual trials as well as the contributions of larger analyses to our understanding of patient selection, prognosis, costs, and outcomes. (J Interven Cardiol 1996;9:89–115)

Primary angioplasty for myocardial infarction improves long-term survival: PAMI-1 follow-up

Primary angioplasty for myocardial infarction improves long-term survival: PAMI-1 follow-up

Community practice of primary angioplasty for myocardial infarction

Community practice of primary angioplasty for myocardial infarction

Editorial: Oxygen radical scavengers as adjuvant therapy for coronary reperfusion

The cornerstone of modern reperfusion therapy is the well-established experimental and clinical observation that timely and sustained restoration of blood flow can limit myocardial infarct size, enhance the long-term recovery of left ventricular function, and improve survival post-infarction [1,2]. Reperfusion has, however, been termed a double-edged sword [3], due in large part to the potentially deleterious burst of cytotoxic oxygen-derived free radicals--most notably the superoxide anion, hydroxyl radical, and their intermediary, hydrogen peroxide--documented to occur upon restoration of blood flow to previously ischemic tissue [4-6]. Indeed, overwhelming attention has focused on the role of these reactive oxygen species in precipitating so-called lethal reperfusion injury (i.e., the death of previously ischemic but viable myocytes by reperfusion per se), a concept that, despite intensive investigation, remains unsubstantiated [7-9]. Oxygen radicals may, however, confound the benefits of early reperfusion by a second means, by triggering platelet aggregation [10] and thereby contributing to acute reocclusion following initially successful thrombolysis [2,11,12]. In contrast to the uncertainties surrounding lethal reperfusion injury, the incidence and dire consequences of recurrent occlusion are clear. For example, recent analysis of data from the Primary Angioplasty in Myocardial Infarction (PAMI) trial revealed a significant increase in the rate of death or reinfarction, a greater need for further interventional procedures, and prolonged hospitalization in the 28% of patients initially reperfused with recombinant tissue-type plasminogen activator (rtPA) who subsequently developed recurrent ischemia [12]. This editorial focuses on this second and less well-appreciated facet of free radical production in the setting of ischemia/reperfusion, and asks the question, Does adjuvant therapy with oxygen radical scavenging agents offer a promising therapeutic strategy to maintain vessel patency and maximize the benefits of early reperfusion? The Premise: Oxygen Radicals Trigger Platelet Aggregation

Should community hospitals perform angioplasty for acute myocardial infarction?

A debate about the advantages and disadvantages of community hospitals performing angioplasty for myocardial infarction, even if they have no facilities for heart surgery.