Guidelines

When do you use PCI vs fibrinolysis?

When do you use PCI vs fibrinolysis?

Primary percutaneous coronary intervention (PCI), when performed in a timely manner, is preferred to fibrinolytic therapy for reperfusion therapy during ST‐segment–elevation myocardial infarction (STEMI). However, logistical barriers limit the availability of primary PCI for most patients worldwide.

Which is better PCI or thrombolysis?

Primary PCI was superior to thrombolytic therapy in our trial, in the 3 largest previously reported randomized trials,1-3 and in the latest meta-analysis of all randomized trials. Although the incidence of outcomes differs among these studies, the direction of benefit was the same, all favoring primary PCI.

When is thrombolysis preferred over PCI?

In fact, PCI is suitable for more than 90% of patients (thrombolysis can be applied only to 60–80% of the presenting population), establishes initial TIMI flow grade 3 in 70–90% of cases and nearly eliminates the risk of intracranial hemorrhage [6].

What is door to balloon time for STEMI?

Based on the association between shorter times to reperfusion and lower mortality in patients with ST-segment–elevation myocardial infarction (STEMI),1,2 consensus guidelines recommend a door-to-balloon (D2B) time of 90 minutes or less for STEMI patients undergoing primary percutaneous coronary intervention (PCI).

Why is PCI preferred over thrombolysis?

Alternatively, PCI is preferred if the medical contact-to-balloon time is less than 90 min and the delta time is less than 60 min, or if there are other reasons (eg, contraindications to thrombolysis, symptom onset of more than 3 h or high-risk STEMI [cardiogenic shock, or Killip class 3 or greater]).

Why is PCI preferred over fibrinolytic therapy?

Mechanical revascularization, or primary percutaneous coronary intervention (PPCI), of the infarct artery is the preferred method of restoring coronary perfusion because of its superior efficacy and decreased risk of complications compared with fibrinolytic therapy.

Can PCI be done after thrombolysis?

The timing of PCI after thrombolysis can be classified as immediate (as soon as possible after thrombolysis), early (within 24 hours after thrombolysis), rescue (performed only for failed thrombolysis) or deferred (more than 24 hours after thrombolysis).

Is thrombolysis a PCI?

Primary percutaneous coronary intervention (PCI) and thrombolysis are approved therapies in the treatment of ST-elevation myocardial infarction (STEMI). Many clinical trials have shown that primary PCI provides better results than thrombolysis for the STEMI treatment.

What is the difference between PCI and primary PCI?

Primary PCI for STEMI is a much higher risk procedure than PCI for stable patients or for non-STEMI acute patients. PPCI patients have a much higher rate than stable PCI patients of requiring a second visit to the cath lab for repeat procedure (after stent thrombosis), intra-aortic balloon pump insertion etc.

When is CABG indicated over PCI?

CABG is the preferred option for left main disease with 2- and 3-vessel disease and a SYNTAX score >32. CABG is also the preferred option even in the presence of a lower SYNTAX score when multiple complex lesions are present and PCI remains technically limited to achieve complete revascularization.

How do you reduce door-to-balloon time?

5 Ways to Reduce Door to Balloon Time

  1. Transmitting ECGs from the field to the hospital.
  2. Training EMS staff to read and interpret PH-ECGs.
  3. Cross-training staff to prepare the cath lab.
  4. Direct transfer to catherization.
  5. Immediate access to patient ECGs.

Can PCI be done after 12 hours?

Primary PCI is recommended in unstable late presenters, whereas routine PCI should only be considered in stable STEMI patients presenting 12 to 48 hours after symptom onset.

What is goal for PCI treatment?

In the setting of acute ST-elevation myocardial infarction (STEMI), the primary goal of percutaneous coronary intervention (PCI) or fibrinolysis is to reestablish patency of the affected coronary artery and thereby improve perfusion of the myocardium.

Is thrombolysis the same as fibrinolysis?

Thrombolysis refers to the dissolution of the thrombus due to various agents while fibrinolysis refers specifically to the agents causing fibrin breakdown in the clot.

What is PCI and fibrinolysis?

INTRODUCTION. In the setting of acute ST-elevation myocardial infarction (STEMI), the primary goal of percutaneous coronary intervention (PCI) or fibrinolysis is to reestablish patency of the affected coronary artery and thereby improve perfusion of the myocardium.

How are thrombolytics administered?

Systemic thrombolysis is used for heart attack, stroke and pulmonary embolism. The “clot-busting” drug will be delivered through a peripheral intravenous (IV) line, usually through a visible vein in your arm. Performed at your bedside in an intensive care unit while your heart and lung functions are monitored.

When is PCI recommended?

Overall, medical therapy is recommended as first-line therapy in patients with stable angina unless one or more of the following indications for cardiac catheterization and PCI or CABG are present: Severe symptoms. A change in symptom severity. Failed medical therapy.

What should I know about nitroglycerin before using it?

You should not use nitroglycerin if you are allergic to it, or if you are using medicine to treat pulmonary arterial hypertension, such as riociguat ( Adempas ). Do not take erectile dysfunction medicine ( Viagra, Cialis, Levitra, Stendra, Staxyn, sildenafil, avanafil, tadalafil, vardenafil ).

What is the age limit for nitroglycerin?

Nitroglycerin (oral/sublingual) is not approved for use by anyone younger than 18 years old. How should I take nitroglycerin? Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

How many mg of nitroglycerin is in a tablet?

Generic nitroglycerin comes in the form of a sublingual tablet. The strengths of these tablets are 0.3 mg, 0.4 mg, and 0.6 mg. Brand-name nitroglycerin, Nitrostat, comes in the form of a sublingual tablet. The strengths of this tablet are 0.3 mg, 0.4 mg, and 0.6 mg.

How long does nitroglycerin last in the body?

Some forms of nitroglycerin last much longer in the body than others. Nitroglycerin as well as the onset and duration of action of each form is different. The sublingual or tablet spray of nitroglycerin has a two minute onset and twenty five minute duration of action.