Treating ST-elevation myocardial infarction

Treatment of patients with acute ST-elevation myocardial infarction (STEMI) has moved from thrombolysis to primary percutaneous coronary intervention (PPCI) over the past 20 years. This is a result of evidence that the latter has superior long-term benefits for patients. However, there is little research on whether patients who present after the mandated time of less than 120 minutes from onset of signs and symptoms could benefit from primary thrombolysis followed by rescue percutaneous coronary intervention (PCI), referred to here as angiography. This article, which includes a case study, describes the pathophysiology of cardiovascular disease, acute coronary syndrome, and STEMI, and examines some of the literature that compares primary PCI to thrombolysis followed by angiography. It also highlights gaps in research, and encourages practitioners to consider administering thrombolysis to patients who do not present within 120 minutes of the onset of signs and symptoms of STEMI.