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- W2233473669 abstract "Prompt restoration of normal blood flow in the infarct-related artery is essential to myocardial salvage and mortality reduction in patients with an STEMI. The necrosis of viable myocardial tissue mainly happens during the 30 to 90 min after coronary artery occlusion. The metaanalysis of all randomized trials of prehospital versus in-hospital thrombolysis shows that reducing treatment delay by 1 hour saves approximately 20 lives per 1000 patients treated. Several issues should be considered in selecting the type of reperfusion therapy: time from onset of symptoms, risk of STEMI, risk of bleeding and time required for transport to a skilled PCI laboratory. If the duration of symptoms is less than 3h, treatment is more time-sensitive and the superiority of out-of-hosptital fibrinolytic therapy, immediate in-hospital fibrinolytic therapy or transfer for primary PCI is not yet established clearly. Primary PCI is recommended for STEMI patients presenting later than 3h but less than 12h after onset of symptoms, provided that transfer can be achieved rapidly (less than 60 min). If PCI is unavailable, then the benefit of pharmacological reperfusion therapy should be balanced against the risk. Certainly, fibrinolytic therapy administered out-of-hospital within the first 2h (especially the first hour) can occasionally abort AMI and dramatically reduce mortality. EMS physicians who give fibrinolytic therapy must be aware of its contraindications and risks. Before pre-hospital fibrinolysis programmes can be commenced, it is desirable that all medical practitioners involved should receive adequate training in collaboration with the central supporting service. We reported the model of education for pre-hospital fibrinolysis provided by Association for emergency cardiology of Vojvodina, a few years ago. That model is the first on territory of former Yugoslavia. The efficacy and safety of the pre hospital strategy is now recognised worldwide. The described indications are still only recommendations and definite decision is based on the individual patients condition." @default.
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- W2233473669 date "2007-01-01" @default.
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- W2233473669 title "Selection of reperfusion strategy for STEMI and the way of education for EMS physicians in prehospital fibrinolysis treatment" @default.
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