The effects of fibrinolysis post acute myocardial infarction

Abstract

Background: Patients presented at hospital with ST -elevation myocardial infarction will need immediate intervention in order to open the culprit artery, to perfuse the myocardium, improving outcomes and reduce mortality rate. Percutaneous coronary intervention (PCI) is the recommended therapy with minimal risks when performed within 90 min from diagnosis. Due to logistic problems and lack of cardiac catheterization facilities, fibrinolysis remains the ideal therapy for STEMI patients. Patients treated with fibrinolysis are routinely referred for coronary angiography followed by PCI if indicated. Research Question: In a middle aged male who sustained an AMI, does fibrinolysis followed by PCI reduce myocardial tissue damage or both when compared with standard therapy (delayed PCI or ischemia guided PCI). Methods: The PubMed and Cochrane database library were searched for Randomized control trials (RCTs) comparing early PCI after fibrinolysis with delayed or ischemia guided PCI in STEMI patients. Relevant references from retrieved studies were further searched using Google scholar search engine. 7 RCTs were retrieved for analysis. 2 meta-analyses and a systematic review which included these 7 RCTs in their analyses were also included to help in further analyzing these RCTs Results: It was concluded that early PCI after fibrinolysis reduces the risk of re-ischemia and re-infarction at 30 days after randomization. These benefits were sustained up to 6 months and one year. Mortality rate was also reduced however this was not highly significant when compared to delayed PCI strategy. Conclusion: Results of the literature analysed supports the strategy of early PCI after fibrinolysis. High risk STEMI patients should benefit from this strategy when performed within 24 hours from fibrinolysis. Those patients who show successful perfusion without complications after fibrinolysis should have routine coronary angiography before discharge. Recommendation: Health Authorities should analyse statistics on STEMI patients admitted to hospital without cardiac catheterization facilities to be able to develop protocols and guidelines that can improve the care strategies provided to these patients. Staff involved in the care of these patients should be provided with research based education, skills and training. On the other hand the general population should be taught how to recognizing signs and symptoms of cardiovascular diseases and encouraged to seek medical care immediately.