Thrombolytic therapy in STEMI

The care of patients with ST elavation myocardial infarction (STEMI) had transformed in conjunction with major shifts in the approach to reperfusion therapy from primarily pharmacologic to catheter-based strategies. With simultanous advance in medical therapy, the case fatality rate for patients with STEMI has continued to decline When performed rapidly after arrival at an experienced center, primary PCI is superior to pharmacologic reperfusion therapy. However, randomized data showes that very early fibrinolysis may be at least as effective as primary PCI. Consequently decision making for individual patient remains complex regarding the optimum form of reperfusion therapy, specially when a delay until PCI is anticipated This presentation offer basic information about indications,contraindications, efficacy and complications of fibrinolytic therapy and how to select reperfusion strategy as well as choice of the agent according to the ease of dosing, cost and local health care system protocols. The presentation is structured as follows 1. General concepts of reperfusion therapies 2. Pathophysiology of myocardial reperfusion 3. Assesment of reperfusion 4. Selection of reperfusion strategy 5. Effects of fibrinolysis on mortality and LV function 6. Comparison of fibrinolytic agents 7. Complications of fibrinolytic therapy 8. Recommendation for fibrinolytic therapy (indications,contraindications and adjunctive therpay to support reperfusion with fibrinolytic therapy) according to newest ACC/AHA guidelines)