Melissa Walton-Shirley, MD, FACP, FACC


June 04, 2007


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Eighty percent of patients with acute coronary syndrome (ACS) present to centers without a coronary bypass surgery program.[1] Delays in therapy translate into poor left ventricular function, increased mortality, and are directly proportional to the rate of the development of congestive heart failure, our most expensive disease.[2]

In our American population, where heart disease precipitates early mortality more than any other diagnosis, healthcare providers are obligated to improve accessibility to primary percutaneous-based intervention for ST segment elevation myocardial infarction. Improved pharmacologic therapy, better stent platforms, and the advancement of wire technology have sharply decreased the need for emergency transfer for surgical intervention to less than 0.5% of all acute coronary intervention cases.[3] These improvements should motivate us to make the greatest push in the history of American cardiac medicine to level the playing field for all ACS patients.

All invasive cardiac laboratories with access to interventionalists should be urgently brought into programs that will allow for appropriate support staff training. These programs should be paired with chest pain center accreditation which will significantly decrease door-to-balloon time by impacting triage strategies. Elective percutaneous coronary intervention programs should be opened simultaneously in order to increase acuity for procedures and optimize equipment utilization. The number of hospitals that can participate in these projects should not be limited to avoid the ongoing discrimination against patients who arrive at our doors as noncandidates for lytic therapy. Training for all noninterventional invasivists should be made easily attainable to improve access to emergent percutaneous-based coronary therapy.

Standing on the shoulders of our admirable European counterparts who have already pioneered emergency percutaneous-based intervention in nonsurgical hospitals, we too can be successful in delivering excellent care to all Americans who present with acute coronary syndrome.

That's my opinion. I'm Dr. Melissa Walton-Shirley, the forum moderator for and co-director of the Kentucky Pilot Project for primary angioplasty.


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