Role of fibrinolytic therapy in the current era of ST-segment elevation myocardial infarction management.
In patients presenting with ST-elevation myocardial infarction, early, effective reperfusion of the culprit artery is needed to salvage myocardium, maintain left ventricular function, and reduce mortality. According to American College of Cardiology/American Heart Association guidelines for the treatment of these patients, the time from medical contact (i.e., firm ST-elevation myocardial infarction diagnosis) to initiation of fibrinolytic therapy (door-to-needle time) should be 30 minutes, and the time from medical contact to percutaneous coronary intervention (PCI) (door-to-balloon time) should be 90 minutes. Because many patients present to hospitals that are not equipped to administer PCI, door-to-balloon time often falls far short of the ideal. When PCI is not readily available, efficient prehospital treatment with t-PA-based fibrinolytic agent formulations that can be delivered in a bolus and do not require weight-based adjustment may reduce mortality rates and result in outcomes similar to PCI when administered promptly.
Smalling
Richard W
RW
University of Texas Medical School at Houston, Houston, TX 77030, USA. richard.w.smalling@uth.tmc.edu
D004632:Emergency Medical Services; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D015912:Thrombolytic Therapy
D005343:Fibrinolytic Agents