Treating acute myocardial infarction

The decrease in mortality related to acute myocardial infarction in Quebec is good news.1 However, it is difficult to isolate the exact reasons for this decline. Daniel Kollek is right to point out the role of prehospital and emergency room care; the decrease in mortality should encourage health care professionals involved at all stages of caring for patients with acute myocardial infarction to continue to work to ensure delivery of the type of care that has been shown to be effective.

Our data do not allow us to reach a firm conclusion about the role of primary angioplasty in the care of these patients. The decline in mortality might have been greater had primary angioplasty been more readily available in Quebec.

William Panton suggests the use of magnesium therapy for patients admitted to hospitals that are not fully equipped to carry out invasive cardiac procedures. Thrombolytic therapy certainly can be used in peripheral hospitals and it is more effective than use of magnesium sulfate. Magnesium sulfate has been extensively studied; its effectiveness remains controversial in view of the contradictory conclusions of a meta-analysis and a large clinical trial. Before we push the use of controversial treatments, we should maximize the use of treatments that are known to be effective.