The relationship between total ischemic time and mortality in patients with STEMI: every second counts

We read with great interest the recently published article in the October 2016 issue of JACC Cardiovasc Interv by Rashid et al. (1). Briefly, it was a retrospective, single center study that analyzed ST-elevation myocardial infarction (STEMI) patients with symptom onset <12 hours. Patients with primary percutaneous intervention (PCI) were compared with those who received fibrinolytic therapy prior to arrival at the hospital due to non-availability of primary PCI. The authors concluded that the pharmaco-invasive strategy was associated with similar rates of the composite endpoint of mortality, reinfarction, or stroke as compared with a primary PCI strategy. There was propensity for increased bleeding in the pharmaco-invasive group, with a significant fraction (approximately 1 in every 21 patients) having major bleeding, including intracranial bleeding.