Prehospital and in-hospital thrombolysis have success rates comparable to primary PCI when initiated within 2-3 hours of symptom onset, and should not be withheld if PCI is delayed >90 minutes.
Does prehospital thrombolysis improve mortality in patients with acute STEMI compared to primary PCI when PCI cannot be offered within 90 minutes?
Thrombolytic therapy should not be withheld in favor of mechanical reperfusion if primary PCI cannot be offered within 90 minutes for STEMI patients presenting within 2-3 hours of symptom onset.
Although the medical and technological revolution in the last three decades has improved clinical outcome in patients presenting with acute STEMI, residual morbidity and mortality are still high. It is widely acknowledged that the key factor in the successful treatment of AMI is the time elapsed between the onset of symptoms and initiation of therapy. The obvious step in the continuing effort to shorten time-to-treatment and thus to achieve maximal myocardial salvage is the use of prehospital thrombolysis. According to the mortality data, pre-hospital and also in-hospital thrombolysis has success rates comparable with Pri.PCI when initiated within the first 2–3 h after the onset of pain. Therefore, in these patients, thrombolytic therapy should not be withheld in favor of mechanical reperfusion if it cannot be offered within 90 min.
Gupta et al. (Thu,) conducted a review in Acute STEMI. Prehospital thrombolysis vs. Primary PCI was evaluated on Mortality / success rates. Prehospital and in-hospital thrombolysis have success rates comparable to primary PCI when initiated within 2-3 hours of symptom onset, and should not be withheld if PCI is delayed >90 minutes.