University of Vermont College of Medicine, Burlington, VT, USA
Guidelines exist to help operators, hospitals and regions provide best practices for treating patients with ST-elevation myocardial infarction (STEMI): the recommendations of guideline writing groups are based upon the best evidence available and provide a foundation upon which to build a primary PCI programme1,2. Thus, it is interesting to discover areas where guidelines are potentially ignored. An example of such discordance was evident 15 years ago: the STEMI guidelines cautioned against routine angiography after fibrinolysis (Class IIB)3. However, the majority of clinicians in the USA ignored this advice and proceeded early to the catheterisation laboratory to confirm and potentially improve ...
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