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Updated: Aug 19, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 26, 2013
Detecting failed thrombolysis in the accident and emergency department
1Faculty of Health, Institute of Nursing and Midwifery, University of Brighton, Westlain House, Village Way, Falmer, BN1 9PH, Brighton, UK. C.M.Spiers@brighton.ac.uk
Insights
Identifying failed thrombolysis in ST segment elevation myocardial infarction (STEMI) is crucial for patient outcomes. This article reviews simple, non-invasive criteria for early recognition and intervention in emergency departments.
Area of Science:
- Cardiology
- Emergency Medicine
Background:
- ST segment elevation myocardial infarction (STEMI) management prioritizes rapid reperfusion of the infarct-related artery.
- Primary angioplasty is the gold standard, but intravenous thrombolysis is the most common first-line treatment in the UK due to resource limitations.
- Thrombolysis offers significant benefits but has a failure rate of 30-40%, leading to poor prognosis and increased mortality.
Purpose of the Study:
- To identify simple, non-invasive criteria for assessing successful reperfusion after thrombolysis in STEMI patients.
- To facilitate swift recognition of 'failed thrombolysis' in the accident and emergency department.
- To discuss current management strategies for patients who do not achieve adequate reperfusion.
Main Methods:
- Review of data from thrombolytic trials to identify reperfusion success rates.
- Discussion of diagnostic criteria for assessing infarct-related artery patency.
- Exploration of approaches for recognizing failed thrombolysis in emergency settings.
Main Results:
- A significant proportion of STEMI patients (30-40%) do not achieve adequate reperfusion with standard thrombolytic therapy.
- Inadequate reperfusion is associated with a poor prognosis and increased mortality rates.
- Simple, easy-to-interpret, non-invasive criteria are needed to identify treatment failure.
Conclusions:
- Early identification of failed thrombolysis is essential for STEMI patients treated with thrombolysis.
- Implementing simple diagnostic criteria in emergency departments can improve patient management.
- Prompt intervention following recognition of failed thrombolysis is critical to improve outcomes.
Abstract:
The primary objective in managing a patient with ST segment elevation myocardial infarction (STEMI) is to establish reperfusion in the infarct-related artery and to maintain it. Two approaches to coronary reperfusion are used in the UK - primary angioplasty and intravenous thrombolysis. Primary angioplasty is the gold standard approach to managing STEMI, but in the UK (due to financial, resource and personnel limitations) this is not the first-line treatment. Thrombolytic therapy remains the most widely used approach and the benefits of such an approach are irrefutable; thrombolysis saves lives, reduces infarct size and limits left ventricular dysfunction. However, data from the thrombolytic trials also suggest that 30-40% of patients fail to reperfuse with standard thrombolytic therapy. Similar data demonstrates that patients who do not sustain adequate perfusion in the infarct-related artery have a poor prognosis and increased mortality rates. As long as thrombolysis remains the standard therapy for STEMI, it is important that patients in whom the treatment has been unsuccessful are swiftly recognised and appropriate interventions instituted. The criteria to assess successful reperfusion of the infarct-related artery need to be simple to apply, easy to interpret and non-invasive. This article will discuss the most useful criteria to make such a diagnosis and suggest approaches to enable recognition of 'failed thrombolysis' in the accident and emergency department. The current views on managing failed thrombolysis will conclude the article.
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