Pre-hospital thrombolysis: end of an era?

For much of the last 20 years thrombolysis has been the preferred initial treatment for ST segment elevation myocardial infarction (STEMI). This treatment was originally given in hospital but was later used extensively and successfully before hospital admission. Primary percutaneous coronary intervention (PPCI) has proved itself to be more efficacious than thrombolysis, if it can be delivered within two hours, despite the extra time it takes to take patients to a Heart Attack Centre. Giving thrombolysis prior to the PPCI does not buy time safely. Prehospital thrombolysis still has a role when events long journies prevent timely access to the catheter laboratory.