Pre-hospital thrombolysis in perspective.

Abstract

To review existing evidence on the role of pre-hospital fibrinolysis in patients with ST-elevation myocardial infarction (MI). Overview of current guidelines and data from trials and registries on the best perfusion approach for acute MI with ST-elevation. Despite advances in the treatment of ST-elevation MI, the mortality rate before any therapy is administered is high, with half of all fatalities occurring within 2 h of symptom onset. Current treatment options, including the timely use of pre-hospital fibrinolysis, have reduced the overall 1 month mortality. Mortality can be further improved when patient characteristics, risk factors and time delays to treatment are considered. Time factors are essential in the success of fibrinolysis, and subsequent coronary intervention seems beneficial.