From the Guidelines
The most effective treatment for STEMI is primary PCI, which should be performed timely in patients with acute STEMI, as it has been shown to be superior to fibrinolytic therapy. For patients with STEMI, the treatment options include:
- Primary PCI: This is the preferred treatment and should be performed within FMC-to-device time ≤90 min, including the inability to transfer the patient timely from a non–PCI-capable to a PCI-capable hospital to achieve FMC-to-device time ≤120 min 1.
- Fibrinolytic therapy: This is an acceptable alternative therapeutic strategy if primary PCI cannot be performed in a timely manner, and should be administered within DTN ≤30 min 1.
- Pharmaco-invasive strategy: This approach, which combines fibrinolysis with subsequent PCI, may be considered in certain situations, such as in low- and middle-income countries where access to primary PCI facilities is limited 1. It is essential to assess the patient's individual situation and determine the most appropriate treatment strategy, taking into account factors such as the time from symptom onset, the availability of PCI facilities, and the patient's clinical condition. In all cases, the goal is to rapidly restore coronary blood flow and minimize damage to the heart muscle, in order to improve outcomes and reduce morbidity and mortality.
From the FDA Drug Label
TNKase is a tissue plasminogen activator, indicated to reduce the risk of death associated with acute ST elevation myocardial infarction (STEMI). Initiate treatment as soon as possible after the onset of STEMI symptoms. TNKase is for intravenous administration only, administered as a single bolus over 5 seconds.
The new treatment for STEMI (ST-Elevation Myocardial Infarction) is tenecteplase (IV), a tissue plasminogen activator, which is indicated to reduce the risk of death associated with acute STEMI. It should be initiated as soon as possible after the onset of STEMI symptoms and is administered as a single bolus over 5 seconds. 2
From the Research
New Treatment for STEMI
The new treatment for STEMI (ST-Elevation Myocardial Infarction) involves a combination of pharmacologic regimens with primary percutaneous coronary intervention (PCI), also known as pharmacoinvasive recanalization 3. This approach aims to restore myocardial blood flow promptly and improve clinical outcomes.
Reperfusion Strategies
Reperfusion strategies for STEMI include:
- Fibrinolysis
- Primary percutaneous coronary intervention (PCI)
- Combination of both methods 4 Primary PCI is considered superior to fibrinolytic therapy when performed rapidly at experienced centers 4.
Management of STEMI
The management of STEMI involves:
- Timely restoration of coronary blood flow
- Antithrombotic therapies
- Secondary prevention strategies 5 The goal of treatment is to achieve reperfusion as quickly as possible, and the management process is affected by multiple factors, including location, patient, and practitioner characteristics 6.
Fibrinolytic Agents
Fibrinolytic agents, such as streptokinase, alteplase, reteplase, and tenecteplase, are used for the management of STEMI 7. These agents can achieve reperfusion and restore blood flow when administered within 12 hours of symptom onset. The choice of fibrinolytic agent depends on various factors, including the patient's weight and the convenience of administration.