The role of fibrinolysis in the era of primary percutaneous coronary intervention.

Most cases of acute myocardial infarction are caused by disruption of an atherosclerotic plaque followed by coronary thrombosis (1). In ST-elevation myocardial infarction (STEMI), the thrombus occludes a major epicardial coronary artery. Such an occlusion is an emergency situation, and flow in the occluded vessel should be restored as fast as possible. Various strategies for reperfusion are available, namely pharmacological reperfusion by fibrinolytic therapy or mechanical reperfusion by primary percutaneous coronary intervention (PCI). Primary PCI has been established as the preferred reperfusion strategy today (2). The percentage of STEMI-patients treated with primary PCI is steadily increasing, and in most European countries, primary PCI is the leading reperfusion strategy (3). In this era of primary PCI, one might wonder whether fibrinolytic therapy should remain a part of the therapeutic armamentarium of acute STEMI. In this overview, we will briefly present the evidence for the benefit of fibrinolytic therapy in STEMI and discuss the role of fibrinolysis in this era of primary PCI. Benefit of fibrinolytic therapy