Treating acute myocardial infarction

Daniel Kollek has made a good point in that most patients with acute myocardial infarction are seen initially by emergency physicians. In most cases, emergency physicians now commence thrombolytic therapy. The increased use of thrombolytic agents has been associated with reduced mortality and improved outcomes in the treatment of patients with acute myocardial infarction.1

However, there are additional factors that may contribute to reductions in in-hospital mortality as well to reductions in mortality following hospital discharge: increased use of medications such as β-blockers, angiotensin-converting-enzyme inhibitors and lipid-lowering agents;2 and increased use of angiography and revascularization procedures.3

Although “primary coronary angioplasty may be the optimal treatment of acute myocardial infarction,”3 it is available in only 10% of hospitals and therefore we must rely on prompt treatment with thrombolysis, which is delivered diligently by Kollek and other emergency room physicians.4 This pattern of practice has improved patients' outcomes.