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In the past ten years, primary percutaneous coronary intervention (PCI) has replaced thrombolysis as the revascularisation strategy for many patients presenting with ST-segment elevation myocardial infarction (STEMI). However, delivery of primary PCI within evidence-based timeframes is challenging, and health-care provision varies substantially worldwide. Consequently, even with the ideal circumstances of rapid initial diagnosis, long transfer delays to the catheter laboratory can occur. These delays are detrimental to outcomes for patients and can be exaggerated by variations in timing of patients' presentation and diagnosis. In this Series paper we summarise the value of immediate out-of-hospital thrombolysis for STEMI, and reconsider the potential therapeutic interface with a contemporary service for primary PCI. We review recent trial data, and explore opportunities for optimisation of STEMI outcomes with a pharmacoinvasive approach.

Original publication

DOI

10.1016/S0140-6736(13)61454-3

Type

Journal article

Journal

Lancet

Publication Date

17/08/2013

Volume

382

Pages

624 - 632

Keywords

Combined Modality Therapy, Fibrinolytic Agents, Humans, Myocardial Infarction, Myocardial Reperfusion, Percutaneous Coronary Intervention, Thrombolytic Therapy, Time Factors