References
Prehospital thrombolysis for STEMI where PPCI delays are unavoidable
Abstract
Background:
Primary percutaneous coronary intervention (PPCI) is the gold standard for treating patients experiencing ST-elevation acute myocardial infarction (STEMI). More than 30 000 patients experience cardiac arrest out of a hospital setting in the UK every year and may be some distance from a PPCI facility.
Aims:
To analyse and consider if a better outcome could be achieved for patients if PPCI was an adjunct to thrombolytic therapy, where delays of ≥60 minutes are inevitable or unavoidable.
Methods:
The current review examined a range of articles, research materials and databases.
Results:
Some studies suggested the use of prehospital thrombolysis while others compared the effectiveness of drug-eluting stents. While the ‘gold standard’ for the treatment of patients experiencing a myocardial infarction is still PPCI, several factors can delay patients from receiving this treatment at an appropriate facility within the recommended time frame.
Conclusion:
Patients may not be able to access PPCI within 60, 90 or 120 minutes for reasons including increasing urbanisation, population growth and NHS hospital funding cuts. If the PPCI unit is some distance away, ambulance crews could start thrombolysis treatment and transmit clinical findings to a specialist cardiologist in the PPCI facility, or stop at a local hospital that could provide thrombolysis.
Primary percutaneous coronary intervention (PPCI), also known as coronary angioplasty, is considered the therapy of choice for patients experiencing ST-elevation myocardial infarction (STEMI) (Weitsman and Meerkin, 2013). However, when myocardial reperfusion is required or if a delay of ≥60 minutes is inevitable or unavoidable, should PPCI be used as an adjunct to thrombolysis therapy—and could this improve patient outcome and long-term prognosis (Mannsverk et al, 2019)? The present discussion focuses mainly on the UK's NHS ambulance trusts’ response to these patients, and explores some of the reasons for potential delays. Although there are a myriad of reasons for delays, this article will focus on a patient's poor understanding of their circumstances and access to a PPCI treatment centre, as well as some of the social, geographic and demographic conditions (such as an ageing population who are more likely to experience complications) who present to 999 services and treatment centres in a 24-hour health service.
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