Contemporary pharmacological reperfusion in ST elevation myocardial infarction

Abstract

Fibrinolysis remains a key therapeutic alternative mode of reperfusion in patients with ST segment elevation myocardial infarction (STEMI). Its venerability relates to the wealth of clinical efficacy evidence, ease of administration, and broad applicability to the large number of patients who cannot receive mechanical reperfusion within a reasonable period of time. This review focuses on recent data that will further enhance the clinician's ability to deliver a pharmacological reperfusion strategy to this patient population. Combined data from clinical trials as well as registry data support implementation of the guideline endorsed pharmacoinvasive strategy for patients unable to achieve rapid primary percutaneous coronary intervention. The most appropriate mode of reperfusion remains dependent upon the time from symptom onset to presentation as well as perceived delay to initiation of mechanical reperfusion therapy, and one strategy does not fit all patients at all times. Additional information is required in the growing population of elderly patients with STEMI to identify the most appropriate approach to reperfusion in this high-risk population. Despite extensive investigation concerning the optimal management of STEMI over the last three decades, significant knowledge gaps exist and the efficient application of current evidence to clinical practice remains elusive.