Abstract
Reperfusion Therapy of Myocardial Infarction: From Classic to Modern Fibrinolysis
Highlights
One of the main changes occurred in medicine in the last 25 years has been reperfusion treatment in acute myocardial infarction
Fibrinolytic treatment was a landmark as the beginning of the “reperfusion era” in STEMI
Streptokinase, the historically most used fibrinolytic drug is far from ideal: in addition to a low reperfusion rate (TIMI 3 flow around 60%), it must be used by intravenous infusion and it has other problems as immunogenicity or hypotension, a big issue in patients with severe heart failure or cardiogenic shock
Summary
One of the main changes occurred in medicine in the last 25 years has been reperfusion treatment in acute myocardial infarction. Fibrinolytic treatment was a landmark as the beginning of the “reperfusion era” in STEMI. Streptokinase, the historically (and currently) most used fibrinolytic drug is far from ideal: in addition to a low reperfusion rate (TIMI 3 flow around 60%), it must be used by intravenous infusion and it has other problems as immunogenicity (which conditions allergies and antibodies) or hypotension, a big issue in patients with severe heart failure or cardiogenic shock. The success of fibrinolysis (as occurs in stroke) is very time-dependent, being clearly more effective within 1st hour of myocardial infarction.
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