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Updated: May 16, 2026
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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Is There Still a Role for Fibrinolysis in ST-Elevation Myocardial Infarction?
C El Khoury1, F Sibellas, E Bonnefoy
1Intensive and Coronary Care Unit, Cardio-Vascular University Hospital, 59 Bd Pinel, Hospices Civils de Lyon, Lyon, 69008, France.
Current Treatment Options in Cardiovascular Medicine
|November 30, 2012
Summary
Modern fibrinolytic strategies, combining immediate treatment with timely percutaneous coronary intervention (PCI), offer outcomes comparable to primary PCI for ST-Elevation Myocardial Infarction (STEMI). These approaches are crucial when immediate PCI is not feasible.
Area of Science:
- Cardiology
- Emergency Medicine
- Interventional Cardiology
Background:
- Fibrinolysis was the standard for ST-Elevation Myocardial Infarction (STEMI), reducing mortality but carrying risks like cerebral hemorrhage.
- Primary Percutaneous Coronary Intervention (PCI) has limitations due to treatment delays, potentially diminishing its benefits compared to fibrinolysis.
- Despite PCI's advantages, fibrinolysis remains relevant in Acute Myocardial Infarction (AMI) management.
Purpose of the Study:
- To evaluate the continued role and modern strategies of fibrinolysis in STEMI management.
- To highlight the benefits of combining fibrinolysis with subsequent PCI in specific patient groups and logistical settings.
- To emphasize the importance of regional healthcare networks for optimizing AMI treatment.
Main Methods:
- Review of current treatment paradigms for STEMI, comparing fibrinolysis and primary PCI.
- Analysis of modern fibrinolytic strategies incorporating immediate fibrinolysis, antiplatelet therapy, and planned PCI.
- Discussion of logistical requirements for effective implementation of these strategies, including hub-and-spoke networks.
Main Results:
- Modern fibrinolytic strategies achieve clinical results similar to primary PCI.
- Fibrinolysis is beneficial for patients experiencing delays in accessing primary PCI.
- A subset of patients (under 75 years, treated early, unable to receive immediate PCI) may benefit most from modern fibrinolytic strategies.
Conclusions:
- Fibrinolysis, when integrated into modern treatment protocols, remains a vital option for STEMI.
- Effective regional healthcare networks and standardized protocols are essential for maximizing the benefits of fibrinolysis-based strategies.
- Ongoing quality improvement initiatives and registries are necessary to ensure proper application of these AMI management strategies.
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