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Updated: Sep 30, 2025

Prehospital Thrombolysis: A Manual from Berlin
05:52

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Effect of prehospital treatment in STEMI patients undergoing primary PCI

Enrico Fabris1, Sara Menzio1, Caterina Gregorio2

  • 1Cardiothoracovascular Department, Division of Cardiology, University of Trieste, Trieste, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|March 15, 2022
PubMed

Insights

Administering antithrombotic therapy early in ST-elevation myocardial infarction (STEMI) patients at first medical contact improves reperfusion and reduces infarct size. This pretreatment strategy enhances outcomes without increasing bleeding risk.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Pharmacology

Background:

  • The optimal timing for initiating antithrombotic therapies in ST-elevation myocardial infarction (STEMI) is not definitively established.
  • This study investigates the impact of administering antithrombotic therapy at first medical contact (FMC) versus in the Cathlab.

Purpose of the Study:

  • To evaluate the effectiveness of early antithrombotic therapy administration in STEMI patients.
  • To compare outcomes between patients pretreated at FMC and those treated later.

Main Methods:

  • A before-and-after observational study design was employed.
  • STEMI patients undergoing primary percutaneous coronary intervention (PCI) were enrolled.
  • Outcomes were assessed before and after implementing a regional pretreatment protocol involving aspirin, heparin, and ticagrelor at FMC.

Main Results:

  • Early pretreatment significantly improved basal Thrombolysis in Myocardial Infarction (TIMI)-flow and reduced the frequency of TIMI 0 flow.
  • Patients receiving early treatment showed reduced infarct size (lower Troponin Peak) and improved left ventricular ejection fraction at discharge.
  • No significant difference in in-hospital BARC ≥ 2 bleeding events was observed between the groups.

Conclusions:

  • An early pretreatment strategy with antithrombotic therapy in STEMI patients is supported by these findings.
  • The study highlights the importance of well-organized STEMI networks enabling prompt treatment initiation at FMC.
Abstract

Keywords:
DAPTSTEMIanticoagulationmyocardial reperfusionprehospitalprimary PCIticagrelor

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