Treatment of ST Elevation Myocardial Infarction from Fibrinolysis to Primary PCI: In Terms of Risks and Benefits

Abstract

The treatment of ST elevation myocardial infarction (STEMI) has undergone significant advances over the past three decades. Current practice guidelines raise the importance of promptly restoring normal coronary blood flow and myocardial perfusion in the infarct zone after the onset of chest pain, through either pharmacologic or mechanical reperfusion strategies. Fibrinolytic therapy remains the most widely used reperfusion strategy worldwide. With the development of newer fibrinolytic agents and adjuvant potent anti-platelets therapies, this approach carries an increased risk of bleeding complications. The current research present up-date review of the use of reperfusion strategies for the treatment of STEMI, using data through the search of MEDLINE, PubMed, EMBASE, as well as related extracts from the annual report of the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. We summarized data from the available studies conducted over the past last 30 years in relation to pharmacologic reperfusion therapy in regards to risks and benefits. Conclusion: Fibrinolytic therapy remains the main reperfusion strategy used for the treatment of STMI worldwide. In the current era, there is a lack of fibrinolytic therapy trials, mainly because of increased focus in mechanical reperfusion therapies’ studies in the developed world. Clinical trials on the use of the fibrinolytics with newer platelet agents are urgently needed.