1. Managing AMI – much work still to do? MONDAY, 28 th FEBRUARY – SESSION 3 Patrick Goldstein EXPERTS WORKSHOP ON EARLY TREATMENT STRATEGIES FOR ACUTE MYOCARDIAL INFARCTION FOR THE MIDDLE EAST COUNTRIES FEBRUARY 26 TH -28 TH 2005 / DUBAI, UAE SPONSORED BY BOEHRINGER INGELHEIM

2. Can We Now Imagine Where Are Our Different Roles in the Modern Management of Acute MI?

3. on scene at the dispatching center at the ER but is that all ? The EP Clearly Has a Place in the Treatment

4. …but the common aim of a multidisciplinary team implementing a strategy of participation and collaboration so acting on the emergency call: yes treating patients on scene: yes transporting patients in a difficult position: yes but It Is Not a Question of EP or Cardiologists…

5. Together promote clinical research create and maintain documentation build evaluation tools: common registers training for coronary emergencies ambulance crews paramedics nurses students physicians promote media campaigns promote new participative and combined strategies

6. Cardiology and Emergency Medicine Ann. Emerg. Med 2002 ; 39 : 164-167 united we stand divided we fall W.B. GiblerDepartment of Emergency Medicine Cincinnati E.J. TopolDepartment of Cardiology Cleveland B. HolfroydDepartment of Emergency Medicine Edmonton P.W. ArmstrongDepartment of Emergency Medicine Edmonton

7. Study Design Randomise AMI open label ASA UFH (bolus) No lytic (Group B) ASA UFH (bolus) TNK (Group A) n = 2000 Cath lab Angiography / PCI (immediate) Stent / clopidogrel (optional) Heparin as routinely used NO GP IIb/IIIa inhibitors, (only bail-out at investig. discretion) Angiography / PCI (immediate) Stent / clopidogrel (optional) Heparin as routinely used GP IIb/IIIa inhibitors can be used at investig. discretion

8. Combined Therapy in the “Real World” Organise pre-hospital fibrinolysis Define High Volume Centers for rescue PCI Availability 24 h / 24 h Direct admission to Cath Lab Define candidates for combined therapy Written protocols Risk / Time to Cath Lab / Ambulance or helicopter Validate the strategy each year

9. Proposal Education of health care providers Clinical investigation Improving routine care Creation of site-specific and multicenter databases Subspecialisation within emergency medicine and cardiology

10. So...Some Keys to Success and… € or $ Enough health care providers Comprehensive institutions Evaluation Training and Teaching Information and Communication

11. Total Reperfusion PCI Fibrinolysis (Rogers et al. J Am Coll Cardiol 2000; 36: 2056-63) Reperfusion During the Last Decade 0 30 10 20 40 90919293949596979899 % YEARS p = 0.0001

12. Cardiologists and Emergency Physicians Definitive progress for the patients but maybe also for the doctors whose progress together is even better as they get to know each other better A lobby or a task force ? EUROPE AND UAE and may be the planet IS SO SMALL