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
(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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