Abstract
On the example of the clinical case of newly diagnosed ST-elevation myocardial infarction combination of different reperfution strategies and their benefit was discussed. Recommendations on lifestyle modification and medicament treatment tactics are described. From one hand, in spite of side-effects of treatment as an increased risk of stroke and hemorrhagic stroke, prehospital FL is associated with a decreased risk of cardiogenic shock and its effectiveness depends on the time from symptom onset to reperfusion. From other hand, despite the fact that PPCI is the recommended default reperfusion strategy, its effectiveness depends also on time limits and absence of the majority of PPCI-facilated hospitals worldwide. Combination of prehospital single-bolus FL following after 3–24h early routine angiography and PCIcan improve post-STEMI survival and help to avoid hyperreactivity and thrombin-induced platelet activation after FL, which can be a key to success in effective treatment and rehabilitationafter STEMI in patients without high risk factors of potential bleeding or stroke.
Highlights
Ischaemic heart disease accounts for almost 1.8 million annual deaths in the world and around 20 % of all deaths in Europe, the STelevation myocardial infarction (STEMI) incidence rate ranged from 43 to 144 per 100 000 per year in different European countries [1]
Despite the fact that the number of studies compared were relatively low, results supported an hypotise that prehospital FL with transfer to percutaneous coronary intervention (PCI) centers is a valid alternative to Primary percutaneous coronary intervention (PPCI), which allows potential limitation of resources allocated to developing proximity 24/7 PCI facilities [4]
For patients presenting in a non-PCI centre, door-in to doorout time, defined as the duration between arrival of the patient at the hospital to discharge of the patient in an ambulance en route to the PCI centre, is a new clinical performance measure, and ≤ 30 min is recommended to expedite reperfusion care [5]
Summary
Ischaemic heart disease accounts for almost 1.8 million annual deaths in the world and around 20 % of all deaths in Europe, the STelevation myocardial infarction (STEMI) incidence rate ranged from 43 to 144 per 100 000 per year in different European countries [1]. Primary percutaneous coronary intervention (PPCI) is preferred for most patients if it can be performed with less than a 90 minute delay from the point of first medical contact. 2018 associated with better prognosis, included similar mortality rates, lower rates of cardiogenic shock, and higher rates of stroke in patients with ST-segment elevation myocardial infarction (STEMI). Despite the fact that the number of studies compared were relatively low, results supported an hypotise that prehospital FL with transfer to percutaneous coronary intervention (PCI) centers is a valid alternative to PPCI, which allows potential limitation of resources allocated to developing proximity 24/7 PCI facilities [4]. The benefit of PPCI over prehospital FL is not clear among patients managed early in the prehospital setting, but both of them are time-dependent with similar rates of mortality [3]
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