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Evidence-Based Heart Attack Care Reduces Deaths: Study
Date:4/27/2011

007, including several that quickly restore blood flow to the heart to prevent further damage, called reperfusion.

The most significant of those is primary percutaneous coronary intervention (PCI), also called balloon angioplasty, in which a catheter is threaded into the artery and a balloon at the end inflates inside the clogged artery. Usually, when the tube is removed, a stent, or wire mesh structure, is left behind to prevent the artery from narrowing again.

About 12 percent of patients underwent primary PCI at the start of the study period. By 2007, 61 percent did. (Primary means the PCI was done soon after the patient arrived at the hospital, usually within 90 minutes, Mukherjee explained.)

The percentage of people who received PCI or bypass surgery within 14 days rose from 10 percent to 84 percent.

In addition, the use of clot-busting, clot-preventing and cholesterol-lowering medications also surged during the study period, the study authors noted.

Use of glycoprotein Ilb/lIIa inhibitors (platelet inhibitors) rose from 0 percent to 55 percent; use of clopidogrel (blood thinner) rose from 0 percent to 82 percent; statin use rose from 23 percent to 83 percent; and use of ACE inhibitors or ARBs (angiotensin II receptor blockers, used to lower blood pressure) rose from 39 percent to 69 percent, according to the report by Dr. Tomas Jernberg, of the Karolinska Institute in Stockholm, and colleagues.

Still, there were differences between hospitals in whether or not patients received the recommended therapies. A similar problem exists in the United States, Mukherjee said.

"Evidence-based therapies take a while to get incorporated into daily clinical practice," Mukherjee explained. "It can take months or years. We see the same thing in the United States, with some hospitals that are very good and some that are not so good."

European evidence-based guidelines for STEMI care are similar to U.S. guidelines developed b
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