Prehospital fibrinolytic therapy followed by urgent percutaneous coronary intervention in patients with ST-elevation myocardial infarction.

In patients with ST-segment elevation myocardial infarction (STEMI) the shorter the reperfusion time, the better the outcome is, regardless of the reperfusion method. Effective, early and rapid reperfusion is the most important goal in the treatment of patients with STEMI. In majority cases of STEMI, transport or transfer to a percutaneous coronary intervention (PCI)-capable center will occur, sometimes bypassing the closest hospital facilities that are not PCI centers. The timely optimal reperfusion strategy might be a prehospital initiated pharmacological reperfusion with subsequent PCI. Reduced-dose prehospital fibrinolysis allows safe transport of STEMI patients to PCI centers for urgent culprit artery PCI, and may be a superior approach compared with transporting patients to the closest non-PCI hospital for fibrinolytic therapy. In this review we will discuss the evidence regarding reperfusion strategies in STEMI patients.