Implementation of reperfusion therapy in ST-segment elevation myocardial infarction. A policy statement from the Belgian Society of Cardiology (BSC), the Belgian Interdisciplinary Working Group on Acute Cardiology (BIWAC) and the Belgian Working Group on Interventional Cardiology (BWGIC).

Acute heart attacks are a major healthcare problem with continuing high mortality and morbidity rates. The major goal in the treatment of acute myocardial infarction (AMI) is the rapid restoration of blood flow and myocardial perfusion in the infarct zone. This can be achieved by either a pharmacological approach (fibrinolysis) or by a mechanical approach (immediate coronary angiography and coronary dilatation of the occluded infarct artery, the so-called primary percutaneous coronary intervention or PCI). A timely application of reperfusion therapy has been shown to influence favourably shortand long-term patient outcome. Data from several large registries have, however, shown that reperfusion therapy is insufficiently implemented in many countries1. A considerable number of patients with ST-segment elevation myocardial infarction (STEMI) do not receive any reperfusion therapy, for a wide variety of reasons, despite its availability and the absence of any contra-indication. In addition, for patients who do have access to reperfusion, preor in-hospital delays can adversely influence the outcome. In this context, a policy conference was organised in Brussels on 30 September 2006 to review the status quo of reperfusion strategies, taking into account existing guidelines and data from registries. In addition, strategies to optimize reperfusion therapy were discussed in regional meetings during 2007. This policy statement presents a summary of the topics discussed at the policy conference and subsequent regional meetings and also refers to the recently published European Society of Cardiology (ESC) guidelines on the management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. This document has been reviewed and approved by the board members of the Belgian Society of Cardiology and its working groups on acute cardiology and interventional cardiology.