Primary Percutaneous Angioplasty Research Articles

Correlation between strain imaging of left ventricle and TIMI flow in patients with acute St-elevation mycocardial infarction undergoing primary percutaneous angioplasty

Correlation between strain imaging of left ventricle and TIMI flow in patients with acute St-elevation mycocardial infarction undergoing primary percutaneous angioplasty

Prognostic significance of left atrial volume index after myocardial infarction

Abstract Background Left atrial (LA) volume has been characterized as a strong predictive factor of cardiovascular and cerebrovascular occurrences after myocardial infarction (MI). Purpose The aim of our study was to examine the prognostic significance of the left atrial volume index (LAVI) in the occurrence of atrial fibrillation, heart failure and stroke after MI. Methods Our study is prospective and includes one hundred patients with acute MI, who underwent primary percutaneous angioplasty immediately after admission to the hospital.. LA volume was measured 48 hours after admission to the hospital, using the Biplane Simson method, which was indexed to body surface area. The patients were followed for 12 months on average. Results The average value of LAVI was higher in patients who had heart failure, atrial fibrillation and stroke after MI. AMI patients who developed heart failure during the observed period had a mean LAVI of 29.9ml/m2 ±6.7, and patients without heart failure had a mean LAVI of 24.0ml/m2 ± 2.0 (p <0.001). Mean LAVI in patients with atrial fibrillation was 33.6ml/m2 ±8.1, and without atrial fibrillation 25.1ml/m2 ± 2.9 (p <0.001). Patients who had a stroke during the observed period had a mean LAVI 35ml/m2 ± 6.9, and patients without a stroke had a mean LAVI 26.3ml/m2 ±5.2 (p <0.001). The results of the univariable logistic regression are presented. Conclusion LAVI value has a statistically significant effect on predicting the occurrence of heart failure, atrial fibrillation and stroke after MI. LAVI is a strong predictive factor after myocardial infarction.

"No-Reflow" Phenomenon: A Contemporary Review.

Primary percutaneous angioplasty (pPCI), represents the reperfusion strategy of choice for patients with STEMI according to current international guidelines of the European Society of Cardiology. Coronary no-reflow is characterized by angiographic evidence of slow or no anterograde epicardial flow, resulting in inadequate myocardial perfusion in the absence of evidence of mechanical vessel obstruction. No reflow (NR) is related to a functional and structural alteration of the coronary microcirculation and we can list four main pathophysiological mechanisms: distal atherothrombotic embolization, ischemic damage, reperfusion injury, and individual susceptibility to microvascular damage. This review will provide a contemporary overview of the pathogenesis, diagnosis, and treatment of NR.

Female gender and mortality in ST-segment-elevation myocardial infarction treated with primary PCI.

To investigate gender difference in mortality among patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous angioplasty (PPCI). We analyzed data from the prospective registries of two hub PPCI centres over a 10-year period to assess the role of female gender as an independent predictor of both all-cause and cardiac death at 30 days and 1 year. To account for all confounding variables, a propensity score (PS)-adjusted multivariable Cox regression model and a PS-matched comparison between the male and female were used. Among 4370 consecutive STEMI patients treated with PPCI at participating centres, 1188 (27.2%) were women. The survival rate at 30 days and 1 year were significantly lower in women (Log-rank P-value < 0.001). At PS-adjusted multivariable Cox regression analysis, female gender was independently associated with an increased risk of 30-day all-cause death [hazard ratio (HR) = 2.09; 95% confidence interval (CI): 1.45-3.01, P < 0.001], 30-day cardiac death (HR = 2.03;95% CI:1.41-2.93, P < 0.001), 1-year all-cause death (HR = 1.45; 95% CI:1.16-1.82, P < 0.001) and 1-year cardiac death (HR = 1.51; 95% CI:1.15-1.97, P < 0.001). For the study outcome, we found a significant interaction of gender with the multivessel disease in females who were at increased risk of mortality in comparison with men in absence of multivessel disease. After the PS matching procedure, a subset of 2074 patients were identified. Women still had a lower survival rate and survival free from cardiac death rate both at 30-day and at 1-year follow-up. As compared with men, women with STEMI treated with PPCI have higher risk of both all-cause death and cardiac mortality at 30-day and 1-year follow-up.

Impact of epicardial adipose tissue increase after ST elevation Myocardial Infarction (STEMI) on IL-13 and left ventricular remodelling

Abstract Background The role of epicardial adipose tissue (EAT) in myocardial diseases is well established, and several evidence suggest that EAT may negatively affect left ventricular (LV) remodelling through an imbalanced production and secretion of pro and anti-inflammatory cytokines. Of these, the IL-13 it is known to play a positive activity on cardiac remodelling. Nowadays, the crosstalk between EAT and the myocardium is still poorly understood and the effects of myocardial ischemia on morphological and functional properties of EAT are almost unknown. Purpose In the present study we explored whether an increase of EAT thickness after STEMI might be associated with unfavourable LV remodelling at 3 months (T1). We also evaluated the relationship between changes (Δ) of EAT thickness and systemic levels of Interleukin (IL)-13 which is known to play a favourable activity on LV remodelling after STEMI. Methods We enrolled 66 patients with first STEMI, undergoing primary percutaneous angioplasty. At baseline and at 3 months we performed a complete echocardiogram, including EAT maximal thickness assessment, and determined circulating levels of IL-13. Results At 3 months after STEMI, the population was stratified into two groups according to different EAT remodelling after cardiac event: Group 1, patients with an increased EAT thickness (Δ EAT&amp;gt;1; 30 patients) and Group 2, patients with unchanged or decreased EAT thickness (Δ EAT&amp;lt;1). The two groups did not differ for age, gender and atherosclerotic risk factors. Group 1 had a worse LV remodelling at 3 months with higher LV diastolic and systolic volumes, lower LV ejection fraction (p=0.003; p=0.013; p=0.013 respectively) and worse diastolic function (E/e'; p=0.011). Of interest, EAT thickness increase was paralleled by circulating IL-13 reduction (p=0.022). Conclusion Myocardial injury can result in EAT increase which is associated to worse LV remodelling probably through the loss of the protective role of IL-13. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This research has been funded by the University of Naples “Federico II” and “Compagnia di San Paolo e l'Istituto Banco di Napoli” within the competitive grant STAR 2018; Valentina Parisi is the principal investigator

Cytoprotection in acute myocardial infarction after the discovery of a heart attack-dependent artery. New perspectives

Direct violation of cell metabolism is the basis of ischemic damage of the myocardium in acute myocardial infarction. L-carnitine positively affects on the exchange of branched chain fatty acids and individual aminoacids and assimilates the mass of free radical compounds. Recent scientific evidence suggests that it stabilizes cell membranes and involved in the control of nuclear transcription.The article presents the case of positive effect of L-carnitine therapy on early left ventricular remodeling, the restoration of vagal-sympathetic interactions, peroxidation of lipids in a patient with acute myocardial infarction after primary percutaneous angioplasty. The course treatment (L-carnitine 3 g/day) brought significant changes in the vegetative maintenance of cardiac rhythm on early stage of disease. The statistical significance of the cardiac rhythm variability was obtained after 1 week of treatment with true significance. Thus, SDNN, RMSSD, pNN50 increased by 42.8–45.3% from the weekend and returned to the limits of the physiological norm. The value of HF increased almost 2 times (from 5211 mc2 to 10261 mc2 ). The obtained results testified to a significant restoration of the parasympathetic tone of the VNS. However, the activity level of the sympathetic part of the autonomic nervous system has been preserved. This was confirmed by the dynamics of LF and HF/LF.The positive effect of L-carnitine on the level of oxidative stress was expressed in the rapid dynamics of indicators of lipid peroxidation and antioxidant system. After 10 days of treatment, increased lipid peroxidation activity significantly decreased. In particular, the level of diene conjugates – by 36.4%, malondialdehyde – by 41.3%, and the increase in the level of ODS by 27.9%, respectively.When compared with the baseline level, under the influence of therapy with L-carnitine, the cavity of the left ventricle decreased, there was a tendency to enlarge the size of the left atrium and the right ventricle. Violation of the relaxation of the walls of the left ventricle has disappeared. The contractile capacity of the myocardium significantly improved on day 10 with therapy – the left ventricular fraction ejection increased from 45% to 51%.

Impact of coronary intensive care unit in treatment of myocardial infarction.

The mortality rate attributed to ST-segment elevation myocardial infarction (STEMI) has decreased in the world. However, this disease is still responsible for high costs for health systems. Several factors could decrease mortality in these patients, including implementation of cardiac intensive care units (CICU). The aim of this study was to evaluate the effect of CICU implementation on prescribed recommended treatments and mortality 30 days after STEMI. We performed a retrospective study with patients admitted to CICU between 2005 and 2006 (after group) and between 2000 and 2002, before CICU implementation (before group). The after group had 101 patients, while the before group had 143 patients. There were no differences in general characteristics between groups. We observed an increase in angiotensin-converting enzyme inhibitors, clopidogrel and statin prescriptions after CICU implementation. We did not find differences regarding number of patients submitted to reperfusion therapy; however, there was an increase in primary percutaneous angioplasty compared with thrombolytic therapy in the after group. There was no difference in 30-day mortality (before: 10.5%; after: 8.9%; p=0.850), but prescription of recommended treatments was high in both groups. Prescription of angiotensin-converting enzyme inhibitors and beta-blocker decreased mortality risk by 4.4 and 4.9 times, respectively. CICU implementation did not reduce mortality after 30 days in patients with STEMI; however, it increased the prescription of standard treatment for these patients.

65. Impact of focused echocardiography in clinical decision of patients presented with STMI, underwent primary percutenouse angioplasty

Echocardiography in coronary artery diseases is an essential, routine echocardiography prior to primary percutaneous angioplasty is not clear. In our clinical practice in primary angioplasty we faced lots of complications either before or during or after the procedure. Moreover, lots of incidental findings that discovered after the procedure which if known will affect the plan of management. One-hundred-nineteen consecutive underwent primary angioplasty. All patients underwent FE prior to the procedure in catheterization lab while the patient was preparing for the procedure. FE with 2DE of LV at base, mid and apex, and apical stander views. Diastology grading, E/E′ and color doppler of mitral and aortic valve were performed. (N = 119) case of STMI were enrolled, mean age 51 ± 12 year. Eleven cases (9.2%) had normal coronary and normal LV function. Twenty cases (17%) of MI complication detected before the procedures: RV infarction 8.4% (5.1% asymptomatic and 3.3% symptomatic), ischemic MR (8.4%), LV apical aneurysm (0.8%), significant pericardial effusion (0.80%). Acute pulmonary edema in 17 cases (14.3%): six cases (5.1%) developed acute pulmonary edema on the cath lab with grade 3 diastolic dysfunction and E/E ′ >20, 9 cases (7.6%) develop acute pulmonary edema in CCU with grade 2–3 diastolic dysfunction and E/E′ 15–20. 2 cases (2.7%) develop acute pulmonary in CCU with grade 1–2 diastolic dysfunction and E/E′ 9–14. One case (0.8%) presented cardiac tamponade 2 h post PCI. Incidental finding not related to STMI were as follow: 2 cases (1.7%) with severe fibro degenerative MR, 2 cases (1.7%) with mild to moderate AR and 2 cases (1.7%) with mild to moderate AS. Isoled CABG 5/4.2% and CABG and MVR 2/1.7%. FE play an important role in guiding the management, early detection the incidental findings and complication post PCI.

TCT-173 Predictors of Sub-Acute Stent Thrombosis in Acute Myocardial Infarction Patients Treated with Primary Percutaneous Angioplasty

Subacute stent thrombosis (SST) (0 – 30 days) remains an important complication post primary percutaneous intervention (PPCI), with morbidity and mortality reaching those of spontaneous myocardial infarction. To date, our information on angiographic and clinical predictors of SST in ST- segment

Left anterior descending coronary artery fistula to left ventricle: The revenge of a well treated myocardial infarction in the era of primary percutaneous angioplasty

To better discriminate between different diagnoses, once patient's informed consent was obtained, we performed coronary angiography which demonstrated the absence of vessel stenosis but the presence of opacification of the left ventricular cavity almost simultaneously with the left coronary tree (Fig. 2B): we identified a multi-vessel like structure originating from the left anterior descending artery (LAD) functioning like a conduit between it and the left ventricular cavity. Comparing this angiography with the previous one made during the acute myocardial infarction seven years before, this structure was not visible (Fig. 2A). Suspecting a new formation not visible with echo, we performed magnetic resonance and computed tomography (Fig. 3 )t o better explore the surface of the heart and the thickness of the myocardial muscle, but no more information was obtained, Therefore we concluded for an acquired coronary artery fistula (CAF) after myocardial infarction. Coronary artery fistula is a rare and usually congenital anomaly (0.05–0.25%of patientswhoundergo coronaryangiographyfor anyrea

Catheter Aspiration after Every Stage during Primary Percutaneous Angioplasty; ADMIT Trial

We assess the epicardial and microcirculation flow characteristics, and clinical outcome by using catheter aspiration after each stage of primary percutaneous coronary intervention (PPCI). Conflicting data are reported regarding early and late benefit of using aspiration catheter in the initial phase PPCI. A total of 100 patients with ST-segment elevation acute myocardial infarction (STEMI) were included: 51 underwent PPCI without using an aspiration device (SA group) and 49 underwent PPCI by activating an aspiration catheter after each stage of procedure; wiring, ballooning and stenting, respectively (MA group). Thrombolysis in myocardial infarction (TIMI) flow grade, TIMI frame counts and myocardial blush grade (MBG) were evaluated in each group during every stage of procedure. Major adverse cardiac events were evaluated in the index hospitalization and during 30 and 180 days of follow-up. A TIMI flow grade 2-3 was more prevalent in the MA group compared with the SA group only after wiring: 65.9 versus 39.1% (p = 0.01), but TIMI frame counts were lower in the MA versus SA group throughout all procedural steps. MBG 2-3 was statistically higher in the MA group compared with the SA group mainly after wiring. After stenting there were no significant changes in both epicardial and microcirculation flow parameters. There were no significant differences between the groups in early and late clinical outcomes. Improved flow parameters were noticed in the MA group only by activating the aspiration device after wiring. This early advantage disappeared after stenting. The initial better flow characteristic in the MA group was not translated into a better early or late clinical outcome.

In-hospital daily insulin dose predicts long-term adverse outcome in patients with diabetes with ST-elevation myocardial infarction treated with successful primary percutaneous angioplasty.

IntroductionEarly initiation of reperfusion therapy including primary percutaneous coronary revascularization (PPCI) has been recognized as a crucial factor determining clinical outcomes in the acute phase of myocardial infarction. In unstable patients with type 2 diabetes mellitus (T2D) the clear benefit from PPCI was proven. We aim to evaluate the prognostic value of factors describing glycometabolic state on admission in patients with T2D undergoing PPCI in acute ST-elevation myocardial infarction (STEMI).Material and methodsProspective analysis of clinical and laboratory variables (mean daily short acting exogenous insulin dose (DID), admission blood glucose, glycated hemoglobin (HbA1c), microalbuminuria) was performed in 112 consecutive patients with T2D with STEMI who underwent PPCI. Women comprised 58% of the group.ResultsInsulin dosing was targeted to obtain a mean daily glucose level < 7.8 mmol/l. During 12-month follow-up 33 (29.5%) major adverse cardiac events (major adverse cardiac events (MACE) consisting of death, reinfarction, and repeated target vessel revascularization) were reported. Microalbuminuria was present in 68 (60.5%) patients. The mean HbA1c level was 7.9%. In the multivariate logistic regression model only DID > 44 IU remained an independent risk factor for MACE (p = 0.02, OR = 5.2).ConclusionsIn patients with diabetes with STEMI treated with PPCI, simple measurement of DID during hospitalization can add valuable prognostic information about the future risk of MACE.

Comparative Short Term Outcomes for ST Elevation Myocardial Infarction (STEMI) Patients using Primary Percutaneous Angioplasty (Primary PCI) Versus Hospital and Ambulance Thrombolysis in a Secondary Level Hospital

Background: Clinical trials have shown superior outcomes for Primary PCI over thrombolysis treatment in patients diagnosed with STEMI. This treatment is however not readily accessible to all patients making thrombolysis an important alternative. We evaluate the outcome of different reperfusion strategies in a secondary hospital.

The impact of chronic kidney disease on in-hospital clinical outcomes in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction

We investigated the effect of chronic kidney disease (CKD) on in-hospital results in patients undergoing primary percutaneous angioplasty for ST-segment elevation myocardial infarction (STEMI). The study included 2,486 patients (2,070 men, 416 women) who were treated with primary angioplasty for STEMI. Of these, 273 patients (11%) were found to have CKD (glomerular filtration rate <60 ml/min/1.73 m2) before the procedure. Patients with and without CKD were evaluated with respect to demographic and clinical features, primary angioplasty findings, and in-hospital clinical results. Patients with CKD exhibited a higher mean age, Killip class, and higher frequencies of female gender, diabetes, hypertension, anemia, and previous myocardial infarction (p<0.05). Angioplasty showed higher rates of right coronary artery lesion, multivessel disease, contrast nephropathy, unsuccessful procedure, and increased stenosis rate and stent length in CKD patients (p<0.05). Cardiovascular mortality occurred in 11.7% and 1.4% of patients with and without CKD, respectively (p<0.001). Patients with CKD had significantly higher incidences of target vessel revascularization, major cardiac events, stroke, cardiopulmonary resuscitation, hemodialysis, ventricular tachycardia/fibrillation, severe heart failure, cardiogenic shock, and significant hemorrhage (p<0.05). Multivariate analysis showed that CKD was an independent predictor of mortality (OR=4.1, 95% CI 1.83-9.17; p=0.001). Our findings show that CKD patients undergoing primary angioplasty for STEMI have an increased risk profile and poorer in-hospital results, and that CKD represents an independent risk factor for mortality.

Intérêt de la mesure du temps de décélération diastolique par Doppler transthoracique dans l’évaluation du phénomène de no-reflow au cours de l’infarctus du myocarde antérieur traité par angioplastie primaire

Aims To assess the value of coronary flow measurement by transthoracic Doppler technique in the detection of “no-reflow” phenomenon. Methods Fourteen patients with first anterior wall infarction treated by successful (TIMI3) primary percutaneous angioplasty and left descending coronary artery stenting were investigated. Myocardial perfusion following PCI was assessed by (i) ST-segment resolution, (ii) MRI-detected microvascular obstruction (early hypoenhancement), (iii) coronary flow pattern measurement by transthoracic Doppler technique. Results Sustained impairment of myocardial perfusion following PCI was observed in a large proportion of the cohort (36% by MRI, 43% by ST regression analysis). Patients with a diastolic deceleration time inferior to 482 ms had higher troponin and CK peak value, higher wall motion index score, lower ST resolution and lower LVEF assessed by MRI. The concordance of the three methods was 80%. Conclusion The measurement of diastolic deceleration time by transthoracic Doppler technique is a reliable technique to identify microvascular obstruction following PCI in acute anterior STEMI. A DDT inferior to 482 ms is associated with sustained “no-reflow” phenomenon.

Surgical or Endovascular Treatment for Chronic Mesenteric Ischemia: A Multicenter Study

To evaluate treatment options for patients with chronic mesenteric ischemia in the United Kingdom. Early and late outcomes of patients with chronic mesenteric ischemia who underwent bypass or percutaneous angioplasty (PTA) in 12 centers were compared on an intention-to-treat basis. A total of 76 patients underwent 101 procedures (PTA 49; bypass 52). Of these, 36 had a PTA first, and 40 had a bypass first. Among those who underwent a primary PTA, nine required a subsequent bypass. Three patients who underwent a primary bypass also required a graft PTA, and three patients required further surgery. Patients who underwent a primary PTA were found to be significantly older and tended to have greater comorbidities. As compared with PTA, primary bypasses were more frequently undertaken in an urgent manner or as an emergency (43% vs. 8%). Perioperative morbidity for bypass was significantly greater than that for PTA (32% vs.6%). Overall, 30-day mortality for bypass tended to be greater than that for PTA (13% vs. 4%; n.s.), but was similar for patients treated electively in the two groups (4% vs. 3%). Cumulative 1- and 5-year survival (bypass: 85%, 63%; PTA: 67%, 31%) and primary patency (bypass: 81%, 69%; PTA: 54%, 32%) rates were found to be significantly better after primary bypass. Treatment preferences were center-dependent. Symptomatic recurrence was found to be less frequent and patency rates were better after a primary bypass. PTA may be a viable alternative in patients with significant comorbidities.

Primary Percutaneous Angioplasty. An Analysis of Reperfusion Delays, Their Determining Factors, and Their Prognostic Implications

The optimum treatment for patients with ST-segment elevation acute myocardial infraction (AMI) is primary percutaneous coronary intervention (PCI), provided that the door-to-balloon time is less than 90 min. The aims of this study were to determine actual treatment times in our patients, to investigate the effect of different factors in reducing those times, and to evaluate the impact of any delay on prognosis. The study involved patients who underwent primary or rescue PCI at our center between January 2005 and October 2007. Treatment times, clinical and angiographic characteristics, and follow-up findings at 1 and 12 months were recorded prospectively. Overall, 389 PCIs were performed: 361 primary and 28 rescue interventions. The median total duration of ischemia was 235 [interquartile range, 170-335] min. The median door-to-balloon time was 79 [53-104] min. The door-to-balloon time was shorter when the ambulance service was able to notify the on-duty cardiologist, who alerted the interventional cardiology team. The difference was 30 [60-90] min (P< .01). Patients who arrived at the emergency department by their own means had the longest door-to-balloon time (100 min vs. 74 min; P< .01). A door-to-balloon time >120 min was associated with higher mortality at 30 days; multivariate analysis showed a clearly increasing trend. The door-to-balloon time at our center was in line with current recommendations, with the time being markedly shorter for patients for whom the ambulance service was able to give advanced warning. A shorter time was associated with a trend towards lower 30-day mortality.

Invasive treatment performed for acute myocardial infarction in a patient with immune thrombocytopenic purpura

Acute myocardial infarction (AMI) is infrequent in patients with idiopathic thrombocytopenic purpura (ITP) so the best treatment is not well known. The next case shows a 37-year-old man with chronic ITP who suffered an anterior AMI, the platelet count at admission was 39,000 μL. He was treated successfully with primary percutaneous angioplasty under anticoagulation with unfractionated heparin and antiaggregation with clopidogrel and ASA. At the end of the procedure we sealed the femoral access site with Angio-Seal®. He didn´t have any complications during the procedure and after six months remained asymptomatic. In some patients with chronic ITP and AMI the percutaneous treatment could be a good option.

Primary endoluminal stenting of transplant renal artery stenosis from cadaver and non‐heart‐beating donor kidneys

This study evaluated the efficacy of primary endovascular stenting in cases of transplant renal artery stenosis (TRAS) from cadaver and non-heart-beating donor kidneys. Patients with TRAS (n = 13) from a single-centre transplant population (n = 476) were treated by primary percutaneous angioplasty and endovascular stenting. The short-term efficacy of this intervention is demonstrated in terms of serum creatinine, glomerular filtration rate (GFR) biochemical, anti-hypertensive medications and mean arterial blood pressure control. Stenting for TRAS was performed in male (n = 10) and female (n = 3) recipients. The median age at transplantation was 55 yr (range 10-67 yr). Stenting occurred at a median duration of 410 d post-transplantation (range 84-5799 d). Mean serum creatinine (pre, 247 micromol/L; post, 214 micromol/L; p = 0.002), GFR (pre, 82.6 mL/min; post, 100.9 mL/min; p < 0.001), arterial blood pressure (pre, 104 mmHg; post, 97 mmHg; p = 0.036) and the number of anti-hypertensive medications required (pre, 3.4; post, 3.0; p = 0.002) showed significant improvement after post-endovascular therapy. There were no serious complications encountered. Primary endovascular stenting of TRAS produces a significant improvement in biochemical parameters of renal graft function and in blood pressure stability, with the benefit of low patient morbidity and single arterial puncture. Primary endoluminal stenting of TRAS is a safe and effective procedure for the treatment of TRAS.

Prise en charge préhospitalière de l'infarctus du myocarde à la phase aiguë dans la région sanitaire VI. Évaluation prospective sur l'année 2002

The treatment of acute myocardial infarction is in evolution. Several strategies are utilized ranging from thrombolysis to percutaneous angioplasty (PCI), and the combination of both treatments; the latter providing an interesting compromise between treatment delay and efficiency of early myocardial reperfusion. We reviewed the early treatment strategies of acute myocardial infarctions undertaken by Samu in region 6 (south west of France) in 2002. Of a cohort of 115 patients, 83 patients (72.1%) had a revascularisation strategy: 56 (48.7%) had a primary PCI, and 27 (23.4%) had thrombolysis (92.6% being performed in the prehospital treatment). In those undergoing thrombolysis, 13 patients (48%) had ongoing features of ischaemia; excluding 4 patients who died during transport, all had a PCI at the admission in hospital. For the 14 patients with successful thrombolysis, 5 had facilitated PCI at the admission, 8 had a delayed angioplasty and 1 patient did not have angiography. Although the number of patients receiving thrombolysis in this study was small, this treatment was begun 62 minutes before primary PCI. There are important intra and extra hospital delays to the commencement of PCI. The easy utility of thrombolysis together with the potential to PCI argue in favour for a strategy of prehospital thrombolysis associated with a facilitated angioplasty.