Insights into the optimal treatment of myocardial infarction

Ischaemic heart disease is the leading case of mortality in Australia and the world. In patients with an acute myocardial infarction time to treatment is a fundamental determinant of infarct size, particularly in those with ST elevation on ECG. Guidelines suggest reperfusion with percutaneous coronary intervention or in some instances thrombolysis. While the notion that ‘time is muscle’ is well known to Cardiologists the traditional focus concentrates on hospital based metrics as evidenced by the development of key performance indicators such as door to balloon time. Improvement in the communication pathways between Emergency departments and Cardiologists has been advocated which also extends to better integration of pre-hospital care in order to minimize treatment delay. This thesis focuses on appropriate treatment of suspected myocardial infarction and the role of reperfusion therapy. It has a particular focus on the role of pre-hospital diagnosis and its integration into more sophisticated treatment pathways, door to balloon time and total ischaemia time. Existing challenges to the diagnosis of acute myocardial infarction and suitability for coronary catheterization are also examined.