Fibrinolytic therapy: what size to fit all?
نویسنده
چکیده
To The Editor: I read with interest the series of articles addressing one of the most interesting debates in modern cardiology.1–3 Unfortunately, for the great majority of patients with acute ST-elevation myocardial infarction (STEMI) in Croatia, use of primary percutaneous coronary intervention (PCI) as a therapeutic option is still a daydream. As in other developing countries, this choice is applicable only for the selected patients who live close to specialized units for PCI and who present early after onset of STEMI. In reality, patients from county hospitals, including my hospital, who come to the emergency department immediately after onset of STEMI have the choice of fibrinolytic therapy with streptokinase. The second choice, but only for a small number of patients treated in the previous 6 months with streptokinase, is alteplase. As we have learned from the results of The National Registry of Myocardial Infarction 2 study, only 31% of patients are eligible for fibrinolytic therapy. So the majority of patients treated for STEMI will not receive reperfusion therapy. Early transportation of patients for primary PCI is not possible in countries where funds are limited. Therefore, we have to better define the most appropriate way for increasing the quality of care for potential STEMI patients. One-size reperfusion therapy will not suffice.
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ورودعنوان ژورنال:
- Circulation
دوره 108 25 شماره
صفحات -
تاریخ انتشار 2003