Mechanical Reperfusion in Patients With Acute Myocardial Infarction Presenting More Than 12 Hours From Symptom OnsetA Randomized Controlled Trial

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Abstract
In patients with acute ST-segment elevation myocardial infarction (STEMI), numerous studies have demonstrated that early reperfusion within 12 hours of symptom onset is associated with increased myocardial salvage, preservation of left ventricular function, and improved survival.1 Due to time-dependent attenuation of the efficacy of thrombolysis,2 the application of this reperfusion modality after 12 hours from symptom onset of acute myocardial infarction (MI) offers no benefit and may be even harmful.1,3,4 Between 8.5% and 40% of patients with acute MI present late after symptom onset, no longer being eligible for thrombolysis.5-9 Despite efforts to reduce time to presentation, recent studies have demonstrated that time-to-arrival has not changed10 or has even increased.6 The lack of efficacy of thrombolysis in patients with acute MI presenting more than 12 hours after symptom onset may be a reason why current guidelines oppose reperfusion therapy in this setting.11

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