, Volume 3, Issue 5, pp 339-344
Date: 26 Aug 2009

Prehospital fibrinolytic therapy for ST-elevation acute myocardial infarction

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Despite advances in medications and interventional techniques, ST-segment elevation myocardial infarction (STEMI) remains a major cause of mortality in the United States. Reducing the time from the onset of symptoms to reperfusion (ischemic time) is the major determinant for mortality reduction. An ongoing controversy exists regarding whether there is more benefit of percutaneous coronary intervention (PCI) preceded by prehospital fibrinolytic treatment (facilitated PCI) compared with primary percutaneous coronary intervention (PPCI) in patients with STEMI. In different clinical trials, prehospital fibrinolysis markedly reduced the time from symptom onset to treatment, allowing earlier ST-segment elevation resolution and higher initial thrombolysis in myocardial infarction (TIMI) flow rates compared with PPCI. After prehospital fibrinolysis, patients who had subsequent PCI had lower in-hospital mortality rates and higher 1-year survival rates compared with those who underwent PPCI. In contrast, fulldose fibrinolytic agents without glycoprotein IIb/IIIa inhibitors immediately followed by PCI may increase major adverse events and should not be used.