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Hamostaseologie 2014; 34(01): 47-53
DOI: 10.5482/HAMO-13-07-0040
Review
Schattauer GmbH

Fibrinolytic treatment of ST-elevation myocardial infarction

Update 2014Fibrinolytische Behandlung des akuten Myokardinfarkts mit persistierender ST-HebungEine Aktualisierung 2014
S. Halvorsen
1   Department of Cardiology, Oslo University Hospital, Oslo, Norway
,
K. Huber
2   3rd Department of Medicine, Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna, Austria
› Author Affiliations
Further Information

Publication History

received: 12 August 2013

accepted in revised form: 18 September 2013

Publication Date:
27 December 2017 (online)

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Summary

Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI), as long as it can be delivered within 90-120 minutes from patient’s first medical contact, and is the leading reperfusion strategy in most European countries. However, as PPCI cannot be offered in a timely manner to all patients, fibrinolytic therapy (FT) is the recommended choice in patients with an anticipated delay to PPCI of >90-120 minutes, presenting early after symptom onset and without contra-indications. FT should preferably be started in the pre-hospital setting. Following FT, all patients should be transferred to a PCI-center for rescue PCI or routine coronary angiography with PCI as indicated. Such a pharmaco-invasive strategy, combining FT with invasive treatment, has recently been shown to be non-inferior to PPCI in patients living in areas with long transfer delays to PCI (>60 minutes).

In this overview, we will briefly present the evidence for the benefit of FT in STEMI, and discuss the role of FT in the current era of PPCI as well as the optimal treatment following pharmacologic reperfusion.

Zusammenfassung

Die primäre perkutane Koronarintervention (PPCI) ist die bevorzugte Reperfusionstherapie bei akutem Myokardinfarkt mit ST-Hebung (STEMI), vorausgesetzt sie kann innerhalb von 90–120 Minuten ab dem ersten Patientenkontakt eingesetzt werden. Sie ist die dominierende Strategie in den meisten europäischen Ländern. Doch die PPCI kann nicht allen Patienten im gegebenen Zeitrahmen angeboten werden. Die Fibrinolyse-therapie (FT) ist die empfohlene Reperfusionsstrategie bei Patienten, die eine längere Wartezeit bis zur PPCI (>90–120 min) haben, sich früh nach Symptombeginn präsentieren und keine Kontra-indikationen aufweisen. Die FT sollte vorzugsweise im prähospitalen Bereich begonnen werden. Anschließend sollten alle Patienten einem PCI-Zentrum zugewiesen werden, entweder für die so genannte „rescue-PCI” bei nicht erfolgreicher FT, oder für eine routinemäßige Koronarangiographie mit nachfolgender PCI, falls indiziert. Eine derartige pharmako-invasive Strategie, welche die FT mit invasiver Behandlung kombiniert, wurde vor kurzem als nicht-unterlegen gegenüber der PPCI bei jenen Patienten dokumentiert, die in Gebieten mit Transferzeiten >60 min zu einem PCI-Zentrum leben. In dieser Übersicht fassen wir Hinweise zusammen, welche die Vorteile einer FT beim STEMI belegen. Ferner wird die Rolle der FT in der Ära der PPCI diskutiert und die optimale Behandlung nach initialer FT dargestellt.

Keywords

Myocardial infarction - fibrinolysis - angioplasty - percutaneous coronary intervention

Schlüsselwörter

Myokardinfarkt - Fibrinolyse - Koronarangioplastie - perkutane Koronarintervention
 

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