Interv Akut Kardiol 2011; 10(5-6): 235-238

Prehospital thrombolytic therapy of myocardial infarction - present and perspective

Karel Dvořák

Kardiologická a interní ambulance, Ostrava

Primary percutaneous coronary intervention is the dominant reperfusion strategy for the treatment of STEMI in most developed countries.

Result of reperfusion therapy, either primary percutaneous coronary intervention (PPCI) or thrombolytic therapy (TT), is the better

the earlier is achieved restoration of a flow in the thrombotic coronary artery. Findings of some registries and studies demonstrated that

mortality of patients with PPCI or TT is practically the same when first medical contact was shorter than 3 hours after signs of myocardial

infarction. Median time of PPCI delay in comparison with TT is at condition of good organisation at PCI centres at least 60 minutes, which is

particularly significant in the first two or three hours after rise of signs. Only one and rather small study CAPTIM compared PPCI a TT. This

study demonstrated only nonsignificant decrease of mortality in TT group. The principles of farmaco-invasive strategy were here applied.

That included TT, aspirin, clopidogrel and heparin, direct transportation to PCI centre. Now we are expecting the results of the STREAM

study, where the farmaco-invasive strategy (TT, aspirin, clopidogrel and direct transportation to PCI centres) and direct PPCI without TT will

be compared in patients up to three hours after rise of STEMI symptoms.

Keywords: myocardial infarction, prehospital thrombolysis, farmaco-invasive strategy

Published: November 1, 2011  Show citation