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A debate about the advantages and disadvantages of community hospitals performing angioplasty for myocardial infarction, even if they have no facilities for heart surgery.

Although data are few, a strategy of angioplasty-after-thrombolysis seems reasonable and beneficial.

Because elderly patients are at greater cardiac risk than younger patients, they have more to gain from treatment. Risk-benefit analysis plays a pivotal role in treatment decision-making, since treatments may pose more risk for older patients.

Readers comment on articles on the diagnosis of acute myocardial infarction (March 2009) and the shingles vaccine (January 2009).

The optimal thrombolytic therapy will be a cocktail of several thrombolytic, antithrombotic, and antiplatelet agents, each of which attacks different pathways of clot formation.

The updated definition includes subtypes of acute MI, imaging studies supporting the diagnosis, and biomarker thresholds after percutaneous coronary intervention and coronary artery bypass grafting.