Rezkalla Shereif H, Ahmed Mubashir
Department of Cardiology, Marshfield Clinic, 1000 N Oak Ave, Marshfield, WI 54449, USA.
WMJ. 2007 Jul;106(4):219-24.
Review of existing evidence supports that percutaneous coronary intervention (PCI) is superior to thrombolytic therapy in patients with acute myocardial infarction. If, however, a dedicated intervention team is not available onsite, transfer to another facility should be considered if reperfusion could be achieved within 90 minutes. If that goal cannot be achieved within 120 minutes, thrombolytic therapy should be administered with a planned transfer to a facility with PCI capability. In patients with cardiogenic shock or recurrence of anginal chest pain, PCI should be immediately considered. The value of administering full or modified dose thrombolytic therapy and then transferring for immediate PCI has not been demonstrated yet. Development of dedicated protocols for management of ST-elevation myocardial infarction developed by a community-based emergency medical service, emergency department, and cardiovascular service is highly recommended.
现有证据回顾表明，在急性心肌梗死患者中，经皮冠状动脉介入治疗（PCI）优于溶栓治疗。然而，如果现场没有专业的介入治疗团队，若能在90分钟内实现再灌注，则应考虑转至其他机构。如果在120分钟内无法实现该目标，则应进行溶栓治疗，并计划转至具备PCI能力的机构。对于心源性休克或复发性心绞痛患者，应立即考虑进行PCI。先给予全量或改良剂量溶栓治疗然后立即转至PCI机构进行治疗的价值尚未得到证实。强烈建议由社区紧急医疗服务机构、急诊科和心血管服务部门制定专门的ST段抬高型心肌梗死管理方案。
