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From the prehospital literature
  1. Malcolm Woollard,
  2. from the British Paramedic Association Research and Andit Committe and the Faculty of Prehospital Care Research Unit
  1. Correspondence to:
 Professor Malcolm Woollard
 Department of Academic Emergency Medicine, The James Cook University Hospital Education Centre, Marton Road, Middlesborough,TS4 3BW, UK; malcolm.woollard{at}

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The falling number of ST elevation myocardial infarctions (STEMI)

A cross sectional study of more than 10,000 patients with acute coronary syndromes (ACS) admitted to 103 hospitals in 25 countries in Europe and the Mediterranean Basin has demonstrated a strong association between STEMI and smoking. Patients who have non-STEMI presentations of ACS tended to have more hypertension and obesity. The welcome decline in smoking may be beginning to manifest in what the authors refer to as ‘‘less severe AMIs’’.

In this study 43% of patients with an ACS diagnosis had a STEMI and the remaining 57% were non-STEMI. These findings provide further confirmation that the balance between STEMI and non-STEMI presentations is shifting: STEMI is on the decline. This has clear implications for provision of emergency cardiac care, including in the pre-hospital setting. There is a need, moreover, to highlight to emergency care personnel the high mortality in non-STEMI patients (and indeed in those who do have …

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  • Competing interests: None declared