Association of Inpatient vs Outpatient Onset of ST-Elevation Myocardial Infarction With Treatment and Clinical Outcomes

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Abstract
Early reperfusion with percutaneous coronary intervention (PCI) or thrombolytic therapy remains the primary goal in the initial treatment of eligible patients presenting to a hospital with ST-elevation myocardial infarction (STEMI). Over the last decade, recognition that this strategy is of critical importance has prompted the development of a number of regional and national initiatives to facilitate and improve systems of care for STEMI. These initiatives, including the Reperfusion of Acute Myocardial Infarction in North Carolina Emergency Departments initiative,1 the American College of Cardiology (ACC) D2B Alliance,2 and the American Heart Association (AHA) Mission: Lifeline initiative,3 have enhanced recognition, reduced time to treatment, improved systems of care, and facilitated access of patients to PCI-capable facilities. Consequently, national median door-to-balloon times improved by more than 30 minutes between 2005 and 2010.4

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