title: Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention?
abstract: In the past ten years, primary percutaneous coronary intervention (PCI) has replaced thrombolysis as the revascularisation strategy for many patients presenting with ST-segment elevation myocardial infarction (STEMI). However, delivery of primary PCI within evidence-based timeframes is challenging, and health-care provision varies substantially worldwide. Consequently, even with the ideal circumstances of rapid initial diagnosis, long transfer delays to the catheter laboratory can occur. These delays are detrimental to outcomes for patients and can be exaggerated by variations in timing of patients' presentation and diagnosis. In this Series paper we summarise the value of immediate out-of-hospital thrombolysis for STEMI, and reconsider the potential therapeutic interface with a contemporary service for primary PCI. We review recent trial data, and explore opportunities for optimisation of STEMI outcomes with a pharmacoinvasive approach.
authors: Leicester Cardiovascular Biomedical Research Unit, University of Leicester, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK. agershlick@aol.com
authors: Anthony H
authors: AH
authors: Gershlick
authors: Adrian P
authors: AP
authors: Banning
authors: Aung
authors: A
authors: Myat
authors: Freek W A
authors: FW
authors: Verheugt
authors: Bernard J
authors: BJ
authors: Gersh
mesh_terms: D003131:Combined Modality Therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000601:surgery*; D015425:Myocardial Reperfusion; D062645:Percutaneous Coronary Intervention; D015912:Thrombolytic Therapy; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents