chapter  20
10 Pages

Fibrinolytics and percutaneous coronary intervention

WithPedro L Sánchez, Francisco Fernández-Avilés

Introduction Cardiovascular disease continues to be the leading cause of death in developed countries – in particular, ischemic heart disease is responsible for more than 50% of cardiovascular deaths. 1 Prevention, rapid diagnosis and appropriate early treatment improve survival and reduce the risk of developing heart failure 2,3 Nonetheless, more than one-third of patients with ST-elevation myocardial infarction (STEMI) who are candidates for reperfusion therapy never actually receive this therapy. 4-7

It is important to remember that reperfusion therapy should be administered as early as possible, given that any delay in its provision is related to worse clinical evolution, increase in infarct size, and higher mortality in the short and long term. 8 Therefore, in patients presenting with chest pain, over a period of less than 12 hours and with evidence of persistent ST elevation or left bundle branch block (LBBB), we should aim to give the patient urgent reperfusion therapy in an attempt to reopen the occluded coronary artery as quickly, effectively, and permanently as possible, and to re-establish epicardial and microvascular blood flow. 9-11 Furthermore, myocardial necrosis can even be aborted if this therapy is administered within the first hours of symptoms onset. 12

Reperfusion therapies: fibrinolysis and primary PCI For early, fast, complete and lasting restoration of epicardial and myocardial flow in patients with ST-elevation myocardial infarction (STEMI), there are two well-established therapies: fibrinolysis and primary percutaneous coronary intervention (PCI).