Acute myocardial infarction: the case for pre-hospital thrombolysis with or without percutaneous coronary intervention

Thrombolytic treatment is effective for the treatment of patients with acute myocardial infarction. The earlier treatment is administered, the better is the outcome and we should move towards the routine use of pre-hospital thrombolysis for most patients. Investment should be made to establish the infrastructure (including training, etc) for this treatment to be available. Percutaneous coronary angioplasty offers additional benefit since it enables TIMI grade 3 flow to be established in the vast majority of patients, including those who did not reperfuse following thrombolysis, as well as treating the underlying stenosis. Most patients should therefore receive pre-hospital thrombolysis (although some will be ineligible for lytic therapy), with a view to immediate angiographic evaluation and PCI where indicated. Again investment will be required to establish such a service in the UK. Studies have shown that patients can be transferred safely and rapidly between hospitals to enable optimal therapy to be administered.