Acute ST Elevation Myocardial Infarction in Patients Hospitalized for Non-Cardiac Conditions: The Next Challenge in Reperfusion Time

E arly animal studies demonstrated that temporary coro-nary artery occlusion does not lead to irreversible myocardial damage. Delayed reperfusion resulted in a wave of myocardial necrosis extending from the subendocardium to the subepicardium. With increasing occlusion times the amount of transmural necrosis increased.1 Further observa-tional studies in humans have demonstrated that early reperfusion therapy can preserve myocardial viability and reduce mortality in patients with acute myocardial infarction. Since the 1980s numerous large randomized trials involving tens of thousands of patients have demonstrated that fibrinolytic therapy can reduce mortality and preserved left ventricular function in patients with suspected acute myocar-dial infarction.2 Furthermore, it has been well established that the earlier reperfusion therapy is started after symptom onset, the larger the mortality reduction, with the absolute mortalit