Management of patients with myocardial infarction: The delays

An early reperfusion of the culprit artery in patients with myocardial infarction leads to a reduction of the infarct size and mortality. The benefit of reperfusion (primary angioplasty or fibrinolysis) is well established in the first 12 hours following the symptom onset, remains discussed between 12 and 24 hours, is not documented beyond 24 hours. The choice of the method of reperfusion (primary angioplasty or fibrinolysis) depends on the estimated delay "first medical contact-balloon inflation" in case of primary angioplasty. The delay "first medical contact-balloon inflation" remains too often higher than recommended delay. The management delay could be due to diagnostic difficulties (atypical symptoms, EKG interpretation) or to the management circuit. The optimal management associates a direct call to centre 15, an early prehospital management, a direct transfer to the cath lab or a prehospital fibrinolysis.