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Is Later Better Than Never?

Raymond J. Gibbons, MD; Cindy L. Grines, MD

JAMA. 2005;293:2930-2932.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

The last 2 decades have witnessed a revolution in acute reperfusion therapy for ST-segment elevation myocardial infarction (STEMI). This therapy has focused on patients who present within the first 12 hours of infarction, in the belief that the benefit of therapy is minimal after that time. However, a significant minority of patients present with STEMI more than 12 hours after the onset of chest pain. In 2 large registry studies,^1-2 patients presenting after 12 hours represented 8.5% and 31.3% of all patients with STEMI. Available randomized trial evidence has until now suggested little role for acute reperfusion therapy in this setting. The Fibrinolytic Therapy Trialist Collaboration³ reported that mortality was not reduced by thrombolytic therapy in patients presenting after 12 hours. Based on these data, existing clinical practice guidelines^4-5 strongly favor the use of acute reperfusion therapy in patients presenting within 12 . . . [Full Text of this Article]

Author Affiliations: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minn; and Division of Cardiology, William Beaumont Hospital, Detroit, Mich.

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