Indications for thrombolysis in acute myocardial infarction
1, patients with STEMI who present to hospitals not equipped for emergency PCI treatment within 12h of onset, who cannot be rapidly transported, and who have no contraindications to thrombolysis should be treated with thrombolysis (I, A).
2.Patients who are seen early (onset ≤ 3h) and cannot undergo intervention in time (I, A), or those who have the conditions for emergency PCI treatment, but the difference between the time from the visit to balloon expansion and the time from the visit to the start of thrombolysis is > 60min, and the time from the visit to balloon expansion is > 90min should be given priority for thrombolysis (I, B).
3. in patients with reinfarction, thrombolytic therapy may be given if coronary angiography and PCI cannot be performed immediately (within 60 min after symptom onset) (IIb, C).
4, for patients with progressive ischemic pain and S-T segment elevation >0.1mV in at least 2 thoracic leads or limb leads even after 12-24h of onset, thrombolytic therapy may also be given in selected patients if emergency PCI is not available (1IB).
5, STEMI patients with symptoms occurring for 24 h and symptoms have resolved, thrombolytic therapy should not be taken (III, C).
Contraindications to thrombolysis for acute myocardial infarction.
1, previous history of cerebral hemorrhage at any time.
2, abnormalities of cerebral vascular structures (e.g., arteriovenous malformations).
3, intracranial malignant tumors (primary or metastatic).
4. history of ischemic stroke or transient cerebral ischemia within 6 months (excluding ischemic stroke within 3h).
5. suspected aortic coarctation.
6, active bleeding or bleeding qualities (excluding menstrual flow).
7, severe closed head trauma or facial trauma within 3 months.
8, chronic, severe, not well controlled hypertension or current severe poorly controlled blood pressure (systolic ≥ 180 mmHg or diastolic ≥ 110 mmHg).
9, dementia or other known intracranial pathology.
10, traumatic (within 3 weeks) cardiopulmonary resuscitation, or major surgery within 3 weeks.
11, recent (within 4 weeks) internal bleeding.
12, recent (within 2 weeks) large vessel puncture that cannot be compressed to stop the bleeding site.
13, infective endocarditis.
14, previous application of streptokinase within 5 days to 2 years, or previous history of allergy to such drugs (no repeat streptokinase use).
In addition, the risk/benefit ratio of patients is unfavorable for thrombolytic therapy according to a comprehensive clinical judgment, especially in those with bleeding tendencies, including severe liver and kidney disease, malignancy, and end-stage tumors.