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Fibrinolytic treatment of ST-elevation myocardial infarction. Update 2014

S Halvorsen1, K Huber

  • 1Dr. Sigrun Halvorsen, Department of Cardiology, Oslo University Hospital Ullevål, 0407 Oslo, Norway, Tel. +47/22 11 91 01; Fax +47/22 11 91 81, E-mail: sigrun.h@online.no; sighalvo@ous-hf.no.

Hamostaseologie
|October 3, 2013
PubMed

Insights

Primary percutaneous coronary intervention (PPCI) is preferred for ST-elevation myocardial infarction (STEMI) when timely. Fibrinolytic therapy (FT) is recommended for delayed PPCI, with a pharmaco-invasive strategy showing non-inferiority in long-transfer-delay areas.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Interventional Cardiology

Background:

  • Primary percutaneous coronary intervention (PPCI) is the standard reperfusion therapy for ST-elevation myocardial infarction (STEMI) within 90-120 minutes.
  • Timely PPCI is not universally accessible, necessitating alternative reperfusion strategies.

Purpose of the Study:

  • To review the evidence supporting fibrinolytic therapy (FT) in STEMI.
  • To discuss the role of FT in the current PPCI era.
  • To outline optimal post-FT management strategies.

Main Methods:

  • Review of existing evidence on FT and PPCI in STEMI.
  • Discussion of clinical guidelines and treatment algorithms.
  • Analysis of the pharmaco-invasive strategy.

Main Results:

  • FT is recommended for STEMI patients with anticipated PPCI delays (>90-120 minutes) and no contraindications.
  • Pre-hospital initiation of FT is preferred.
  • A pharmaco-invasive strategy (FT followed by PCI) is non-inferior to PPCI for patients with long transfer delays (>60 minutes).

Conclusions:

  • FT remains a crucial reperfusion option for STEMI when PPCI is delayed.
  • The pharmaco-invasive approach offers a viable alternative to primary PCI in specific patient populations.
  • Optimal management involves timely FT followed by transfer to a PCI-capable center.

Keywords:
Myocardial infarctionangioplastyfibrinolysispercutaneous coronary intervention

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