From the Guidelines
Thrombolysis plays a crucial role in the management of ST-Elevation Myocardial Infarction (STEMI), particularly in situations where primary Percutaneous Coronary Intervention (PCI) is not readily available or feasible.
Role of Thrombolysis in STEMI Management
- Thrombolysis is a viable alternative to primary PCI if it can be delivered within 3 hours after the onset of chest pain or other symptoms 1.
- The choice of reperfusion therapy is determined by several interconnected factors, including the availability of primary PCI facilities, the patient's eligibility for thrombolysis, and the time interval between the onset of symptoms and presentation 1.
- Thrombolysis is still a recommended treatment option for STEMI patients who present within 3 hours of symptom onset, especially in low- and middle-income countries where primary PCI facilities may be limited 1.
Comparison with Primary PCI
- Primary PCI is generally preferred over thrombolysis due to its superior preservation of myocardium, reduced risk of stroke, and lower rates of major adverse cardiac events (MACE) 1.
- However, thrombolysis can be an effective treatment option when primary PCI is not available or feasible, and it can be used as a bridge to primary PCI in a pharmaco-invasive strategy 1.
Pharmaco-Invasive Strategy
- A pharmaco-invasive strategy, which involves thrombolysis followed by routine coronary angiography and PCI, can be an attractive option for STEMI patients in low- and middle-income countries 1.
- This approach can help improve outcomes by providing timely reperfusion and reducing the risk of complications associated with delayed primary PCI 1.
From the Research
Role of Thrombolysis in STEMI Management
Thrombolysis plays a significant role in the management of ST-Elevation Myocardial Infarction (STEMI), particularly in situations where primary percutaneous coronary intervention (PCI) is not readily available 2, 3, 4. The use of thrombolytic therapy has been shown to reduce mortality rates by as much as 30% if administered soon after symptom onset 5.
Benefits and Limitations of Thrombolysis
The benefits of thrombolysis in STEMI management include:
- Reduced mortality rates 5
- Improved clinical outcomes when used in conjunction with other treatments such as aspirin, clopidogrel, and anti-thrombin agents 5
- Ability to be administered in non-PCI capable hospitals 3 However, thrombolysis also has limitations, including:
- Lower success rates compared to primary PCI 4
- Risk of bleeding complications 6
- Need for improvement of non-invasive markers to predict failure or re-occlusion of the infarct-related artery 5
Current Research and Recommendations
Current research suggests that adjunctive intracoronary thrombolysis at the time of primary PCI may improve clinical and myocardial perfusion parameters without increasing the risk of bleeding 6. Professional societies continue to recommend PCI as the primary means of treatment for STEMI, but thrombolysis remains a viable option in certain situations, such as in non-PCI capable hospitals or during times of limited resources, such as the COVID-19 pandemic 3. Further research is needed to optimize the selection of thrombolytic agents and treatment protocols 6.