By Professor Franz-Josef Neumann
The wider use of reperfusion therapy in patients with heart attack (AMI) can save millions of lives in Europe. Effective reperfusion therapy in an AMI patient can cut the individual risk of dying by half. AMI is caused by a sudden blockage of a coronary artery, one of the vessels supplying the heart muscle with oxygen and nutrients. Effective reperfusion therapy provides a timely and sustainable reopening of the blockage.
The WHO MONICA* project showed that in European centres in the mid-1990s, in-hospital mortality of AMI patients was 13%; this was a time when only about 40% of the patients had reperfusion therapy. Today, specialist centres can provide effective reperfusion therapy to more than 90% of their AMI patients. In such centres, in-hospital mortality rate is now as low as around 5%.
The first development in reperfusion therapy was the application of fibrinolytic agents to dissolve the blood clots causing the vessel blockage. Analysis of data from earlier studies reveals that, on average, fibrinolytic agents can reduce infarct-related mortality rate by 18% compared with no reperfusion therapy. Fibrinolytic therapy is universally available and is still the mainstay of reperfusion therapy where healthcare resources are limited.