Alsomali Mahmoud S, Alateeq Mazen A, Abuzaid Saleh E, AlTurki Abdulrahman M, Alnahdi Yaser A, Koshan Mohammed A, Alsamih Abdulrahman Musaad A, Alsaif Abdulaziz M, Alharbi Shahd, Alharbi Maha Abdullah S, Alyoubi Rawshan Khalid A, Alghamdi Alhassan Ali A, Alanazi Eman Fahad M, Alqahtani Reem Saud H
Emergency Medicine, King Fahad Medical City, Riyadh, SAU.
Emergency Medicine, Prince Sultan Military Medical City, Riyadh, SAU.
Cureus. 2024 Jan 10;16(1):e52045. doi: 10.7759/cureus.52045. eCollection 2024 Jan.
Acute myocardial infarction is a fatal condition. Acute myocardial infarction requires appropriate timely reperfusion therapy to improve the outcomes. Fibrinolysis and percutaneous coronary intervention are the cornerstone strategies for managing such cases. In this review, our objective is to summarize the available evidence concerning the administration of prehospital fibrinolysis and its impact on patient outcomes in patients with acute myocardial infarction. We conducted a comprehensive literature search across PubMed, Cochrane Library, Scopus, and Web of Science databases. Our search strategy included the following terms: "Prehospital," "EMS," "Emergency Medical Services," "ambulance," "Fibrinolytic Therapy," "alteplase," "streptokinase," "reteplase," "tenecteplase," "Acute Myocardial Infarction," and "patient outcomes." We found prehospital administration of fibrinolysis may improve the outcomes and decrease the mortality rate. We found that some recommendations were to use prehospital fibrinolysis only if the percutaneous coronary intervention was not accessible within two hours. Additionally, we discussed recommendations to use newer prehospital fibrinolysis as they have better efficacy and safety outcomes. In conclusion, prehospital fibrinolysis decreases the total ischemic time and improves outcomes in acute myocardial infarction patients when timely percutaneous coronary intervention is not available. The guidelines strongly recommend it when the anticipated time for percutaneous coronary intervention exceeds two hours. Ongoing research optimizes patient selection, treatment tools, and prehospital systems of care.
急性心肌梗死是一种致命疾病。急性心肌梗死需要及时进行适当的再灌注治疗以改善预后。纤维蛋白溶解疗法和经皮冠状动脉介入治疗是处理此类病例的基石策略。在本综述中，我们的目的是总结关于院前纤维蛋白溶解疗法的应用及其对急性心肌梗死患者预后影响的现有证据。我们在PubMed、Cochrane图书馆、Scopus和科学网数据库中进行了全面的文献检索。我们的检索策略包括以下术语：“院前”、“急救医疗服务”、“紧急医疗服务”、“救护车”、“纤维蛋白溶解疗法”、“阿替普酶”、“链激酶”、“瑞替普酶”、“替奈普酶”、“急性心肌梗死”和“患者预后”。我们发现院前应用纤维蛋白溶解疗法可能改善预后并降低死亡率。我们发现一些建议是仅在两小时内无法进行经皮冠状动脉介入治疗时才使用院前纤维蛋白溶解疗法。此外，我们讨论了使用更新的院前纤维蛋白溶解疗法的建议，因为它们具有更好的疗效和安全性结果。总之，当无法及时进行经皮冠状动脉介入治疗时，院前纤维蛋白溶解疗法可减少急性心肌梗死患者的总缺血时间并改善预后。当经皮冠状动脉介入治疗的预期时间超过两小时时，指南强烈推荐使用。正在进行的研究正在优化患者选择、治疗工具和院前护理系统。
