Potential of thrombolytic therapy in the early period of ST-elevation myocardial infarction. Expert consensus

The article presents an overview of the largest randomized and observational studies on the efficacy and safety of primary percutaneous coronary intervention (PCI) and pharmacoinvasive strategy for ST-elevation myocardial infarction (STEMI). The management of STEMI patients is one of the most discussed and pressing issues in modern cardiology, since timely myocardial revascularization significantly affects both patient mortality and long-term prognosis. It has been established that the key factor in choosing reperfusion therapy for STEMI should be the time from the onset of symptoms. Due to the fact that it is not possible to ensure the time before opening the infarct-related artery up to 120 minutes in all patients referred for primary PCI in real-world practice, prehospital thrombolysis can significantly improve their prognosis. Pharmacoinvasive approach with prehospital bolus administration of thrombolytic agents should currently be considered as a priority strategy in STEMI if primary PCI within 120 min after diagnosis is not possible. A pharmacoinvasive approach with prehospital bolus administration of thrombolytic agents should be considered as an alternative to primary PCI in the first 3 hours from the STEMI onset in cases where primary PCI cannot be performed within 1 hour after diagnosis.