PCI treatment strategies related to thrombolytic therapy
Thrombolytic therapy is also recognized as one of the effective therapies for STEMI. Compared to PCI, its efficacy is comparable to that of PCI within 3 hours of STEMI onset, although the overall efficacy is somewhat less. The following are several PCI treatment strategies related to thrombolytic therapy.
1, direct PCI (PrimnryPCI): direct PCI without thrombolysis. the best choice for STEMI reperfusion therapy in hospitals with PCI conditions.
2.Transfer PCI: Transfer PCI means: the local hospital does not have the condition of PCI, need to transfer to the condition of the hospital to perform PCI.
The following patients are suitable.
(1) Thrombolytic therapy is contraindicated or unsuccessful.
(2) Secondary to cardiogenic shock.
(3) Expected time delay < 60 minutes.
(4) Transfer to a qualified PCI hospital (consultation-balloon time <90 minutes).
3. Immediate PCI: PCI for severe residual stenosis immediately after successful thrombolysis was shown to be unhelpful in early data. Recent studies have shown that coronary angiography and PCI (if feasible) are routinely recommended within 3 to 24 hours after successful thrombolysis to improve patient regression. It can be applied even if the patient is asymptomatic and without clear myocardial ischemia.
4. Easy PCI: This intervention is characterized by.
(1) It has been originally planned to perform an emergency intervention.
(2) Drug reperfusion therapy (GPIIb/IIIa antagonist and/or half dose of thrombolytic agent) is given before the intervention is performed. the PACT trial showed that the application of half dose of rt-PA in STEMI patients before transport to the catheterization laboratory for emergency PTCA increased the vascular opening rate without an increase in side effects.
Easy PCI is feasible in high-risk patients and when PCI cannot be performed immediately and the risk of bleeding is low.
5.remedial PCI (remedial PCI): PCI within 12 hours of symptomatic onset after thrombolysis failure, which may be more beneficial for anterior wall infarction, but may not be beneficial for asymptomatic inferior wall AMI.
Indications for remedial PCI.
①those who have failed thrombolysis and have a moderate to large infarct.
(ii) Those with hemodynamic or electrocardiographic instability.
(iii) Those with cardiogenic shock or heart failure.
(iv) Those with persistent evidence of ischemia.
(6) Delayed PCI: PCI performed 1 to 7 days after thrombolysis for lesions with residual stenosis is safe, improves left ventricular function, and may be more beneficial in those who still have evidence of ischemia or multi-branch lesions.
(7) Late PCI: PCI performed in patients with stable STEMI who did not receive reperfusion therapy within the first 12 hours of onset for a period greater than 12 h. Coronary angiography and PCI in these patients within two weeks is not currently advocated.