Pre-hospital Fibrinolysis in the Management of Patients with ST Elevation Acute Coronary Syndrome: Review of the Evidence, Implementation and Future Directions
Time to reperfusion is among the strongest predictors of clinical outcome in patients who present with ST
elevation acute myocardial infarction. When time to access is equivalent, primary percutaneous coronary intervention has
demonstrated superior outcomes to fibrinolysis. However, where significant delays exist in accessing percutaneous
intervention, fibrinolysis has an important role. The potential for fibrinolysis delivery in the pre-hospital setting means
that delays to primary percutaneous intervention need to be considered from the time that the patient becomes eligible for
fibrinolysis in the field. This can be particularly challenging in patients with symptom duration ofless than two hours, as
some evidence suggests fibrinolysis may be particularly beneficial in this early phase. Additionally, access to primary
percutaneous intervention provided by an experienced operator, in a timely manner at any time of the day or night, is not
an available option in many healthcare settings. This review focuses on the current evidence and practice of pre-hospital
fibrinolysis and assesses potential roles for this therapy in the future.
Keywords: Acute myocardial infarction, facilitated percutaneous coronary intervention, pre-hospital fibrinolysis, pre-hospital
thrombolysis, primary percutaneous coronary intervention.
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