Pharmacologic Reperfusion The Value of Thrombolytic Agents in STEMI

The goal of thrombolytic therapy is the reperfusion of coronary arteries acutely occluded by a thrombus. Studies have shown that reperfusion with thrombolytics can result in striking reductions in mortality, in the range of 20% to 52%, with the greatest benefit seen in those patients receiving thrombolytic therapy within 70 min of the onset of symptoms.4-7 In the early GISSI studies, mortality was reduced by 47% if therapy was initiated within 1 hour of onset of symptoms, by 23% if within 3 hours, and by 17% if between 3 and 6 hours (Figure 12.4).8 More recently, other studies have suggested benefit even after 6 hours in some patients, and the American College of Cardiology

Figure 12.4. Percentage of reduction in mortality from AMI reported in the GISSI study as a function of the time to administration of a thrombolytic agent from onset of symptoms. Note that benefit of therapy drops off sharply after the first hour,

(ACC)/American Heart Association (AHA) guidelines currently support treatment within 12 hours from onset of symptoms of STEMI, and up to 24 hours for patients with evidence of ongoing ischemia, such as a stuttering pattern of pain.9-12

Studies have also demonstrated improvement in left ventricular function following thrombolytic therapy, but these benefits are less striking than the improvement in mortality.10

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Stuttering Simple Techniques to Help Control Your Stutter

Stuttering Simple Techniques to Help Control Your Stutter

Discover Simple Techniques to Help Control Your Stutter. Stuttering is annoying and embarrassing. If you or a member of your family stutters, you already know the impact it can have on your everyday life. Stuttering interferes with communication, and can make social situations very difficult. It can even be harmful to your school or business life.

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