Efficiency of fibrinolytic therapy after recommended pain-to-needle time

Espinoza C.; Tipán E.; Saquipay H.; Mero R.; Tipán P.; Cárdenas J.; Valverde J.; Bermeo M.; Cabrera I.; Parra D.; Espinoza Z.C. · Revista Latinoamericana de Hipertension (2024) · DOI: 10.5281/zenodo.10684351

Resumen

Pain-to-needle time (PTN) is defined as the time from chest pain onset till the administration of the thrombolytic injection; representing the total time the artery was occluded and the myocardium was in ischemic conditions. However, thrombolytic therapy is only an option when percutaneous coronary intervention (PCI) is not available within the recommended 120 minutes for door-to-device (DTD) procedures. The impossibility of achieving recommended DTD usually happens in rural institutions, which lack the resources to efficiently transport the patient to the nearest PCI center within such a time lapse. Time is the most valuable resource in the management of ST elevation myocardial infarction, and thus, every approach towards the management of this conditions is confined to narrow time windows. Adherence to these time windows provided by international guidelines has proven to give the best possible results in most scenarios. However, real-world data suggests that many patients, especially those from developing countries, get untimely attention. These ex-temporary patients are excluded from the pharmacologic fibrinolytic option and are at risk of being non-eligible for PCI due to transport delay and protocols. This review aims to analyze the evidence regarding the efficiency and viability of extemporaneous implementation of fibrinolytic therapy in patients outside recommended PTN.

Instituciones: Universidad Nacional de Tumbes