Prehospital fibrinolysis in the patient with acute coronary syndrome with ST-segment elevation: history and recommendations

Fibrinolytic therapy has been called one of the most important advances for achieving coronary reperfusion in the management of acute coronary syndrome with ST-segment elevation. The efficacy of this measure depends on how quickly it is implemented, however. Percutaneous coronary intervention has since been shown to be more efficatious than fibrinolysis. Timely provision of this treatment within the therapeutic window is not available to a large proportion of patients, however, given that it is provided only in specialized centers, a situation responsible for long delays. Prehospital fibrinolytic therapy therefore continues to be an efficatious measure for many. We review the history of fibrinolysis in acute coronary syndrome with ST-segment elevation and offer recommendations for approaches to coronary reperfusion, discussing key points to consider in deciding between fibrinolytic therapy or percutaneous coronary intervention. [Emergencias 2009;21:441-450]