BackgroundPercutaneous coronary intervention (PCI) is today considered a better treatment of ST-elevation myocardial infarction (STEMI) than thrombolytic therapy. However, it is not sure that PCI still is the best treatment if the patient has to be transported a long distance to a PCI-center. In Norway, a lot of patients live far from a PCI-center and will need long transportation to get PCI-treatment.
MethodsThis was a study of literature. MEDLINE/PUDMED and tidsskriftet.no were used to find articles about the subject. Just one person read through the articles and decided which had the right criteria to be included in this study.
Results and DiscussionAfter inclusion and exclusion criteria, ten studies were included: PRAGUE-2, DANAMI-2, Air-PAMI, SIAM-3, GRACIA-1, CAPITAL AMI, CARESS-in-AMI, NORDISTEMI, NRMI and RIKS-HIA. In all the articles there was information about the transportation time of the patients. The randomised studies comparing PCI and thrombolysis, showed that PCI was a better treatment of STEMI than thrombolysis, even if the patients had to be transported to a PCI-centre. When comparing the combination of thrombolysis and PCI with thrombolysis alone, the combination was found to give best results. However, all the randomised studies had relative short transport times. In the NRMI-register, reporting both short and long transport times to PCI, the results were in favour of thrombolysis in cases of long transport delays.
ConclusionsPCI seems to be a better reperfusion treatment of patients with STEMI than thrombolysis, even if the patients need to be transported to a PCI-centre. Thrombolysis in combination with PCI give probably better results then thrombolysis alone. However, most studies have had short transport delays, and studies with long transport delays are needed to find out what is the optimal treatment of STEMI in areas with very long transfers.