[Fibrinolytic therapy in acute myocardial infarct]

Area of Science:

• Cardiology
• Pharmacology

Background:

• ST-elevation myocardial infarction (STEMI) is a critical condition requiring timely reperfusion therapy.
• Direct percutaneous coronary intervention (PCI) is the primary treatment strategy for STEMI.
• Fibrinolysis remains a vital alternative treatment modality for STEMI patients.

Purpose of the Study:

• To review the role and application of fibrinolytic therapy in STEMI management.
• To highlight the importance of timely administration of fibrinolysis when direct PCI is not feasible within 90 minutes.
• To discuss the current landscape of tissue plasminogen activator (t-PA) mutants and their clinical relevance.

Main Methods:

• Review of current clinical guidelines and literature on STEMI treatment.
• Discussion of the pharmacodynamics and clinical applications of various fibrinolytic agents.
• Analysis of treatment timing and patient selection criteria for fibrinolysis in STEMI.

Main Results:

• Over 100 tissue plasminogen activator (t-PA) mutants exist, offering varied fibrin specificities.
• Key fibrinolytic agents in clinical practice include t-PA, rt-PA, tenecteplase (TNK-tPA), and lanoteplase (n-PA).
• Fibrinolytic therapy is indicated for STEMI patients presenting within 4 hours of chest pain onset if direct PCI cannot be initiated within 90 minutes.

Conclusions:

• Fibrinolysis is an essential reperfusion strategy for STEMI, particularly when primary PCI is delayed.
• Optimal outcomes with fibrinolysis depend on prompt administration and appropriate patient selection.
• Concomitant therapy with anticoagulants, antiplatelet, and antiplatelet agents is crucial for managing acute STEMI patients undergoing fibrinolytic treatment.