Publication Date
12-1-2020
Journal
Cardiovascular Drugs and Therapy
DOI
10.1007/s10557-020-07039-0
PMID
32671603
PMCID
PMC7360897
PubMedCentral® Posted Date
7-15-2020
PubMedCentral® Full Text Version
Post-print
Published Open-Access
yes
Keywords
Aged, Female, Guideline Adherence, Humans, Inferior Wall Myocardial Infarction, Male, Practice Guidelines as Topic, Risk Assessment, Risk Factors, ST Elevation Myocardial Infarction, Thrombolytic Therapy, Time-to-Treatment, Treatment Outcome, Fibrinolytic therapy, Guidelines, Reperfusion therapy, ST-elevation myocardial infarction
Abstract
The pivotal studies that led to the recommendations for emergent reperfusion therapy for ST-elevation myocardial infarction (STEMI) were conducted for the most part over 25 years ago. At that time, contemporary standard treatments including aspirin, statin, and even anticoagulation were not commonly used. The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines and the 2017 European Society of Cardiology guidelines give a class I recommendation (with the level of evidence A) for primary percutaneous coronary intervention (pPCI) in patients with STEMI and ischemic symptoms of less than 12 h. However, if the patient presents to a hospital without pPCI capacity, and it is anticipated that pPCI cannot be performed within 120 min of first medical contact, fibrinolytic therapy is indicated (if there are no contraindications) (class I indication, level of evidence A). Our review of the pertinent literature shows that the current recommendation for inferior STEMI is based on the level of evidence lower than A. We can consider level B even C, supporting the recommendation for fibrinolytic therapy if pPCI is not available for inferior STEMI.