Rational Pharmacotherapy in Cardiology

Advanced search

Use of pharmacoinvasive approach to the treatment of patients with ST segment elevation acute coronary syndrome: state of the problem

Full Text:


Role of pharmacoinvasive tactics in the treatment of patients with ST-segment elevation acute myocardial infarction is considered. The expert opinions reflected in the final version of the guideline are given, as well as the results of clinical trials in which the efficacy of thrombolytic therapy at early stage after acute myocardial infarction onset compared
with primary percutaneous coronary intervention. The place of pharmacoinvasive tactics in real clinical practice is discussed.

About the Authors

S. R. Gilyarevskiy
Russian Medical Academy of Postgraduate Education. Barricadnaya ul. 2/1, Moscow, 123995 Russia
Russian Federation

M. V. Golshmid
Russian Medical Academy of Postgraduate Education. Barricadnaya ul. 2/1, Moscow, 123995 Russia
Russian Federation

I. M. Kuz'mina
N.V. Sklifosovsky Research Institute of Emergency Medicine. Bolshaya Sukharevskaya pl. 3, Moscow, 129010 Russia
Russian Federation


1. Steg P.G., James S.K., Atar D., et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J 2012;33:2569-619.

2. Bonnefoy E., Steg P.G., Boutitie F., et al. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J 2009;30:1598-606.

3. Morrison L.J., Verbeek P.R., McDonald A.C., et al. Mortality and pre-hospital thrombolysis for acute myocardial infarction: A meta-analysis. JAMA 2000;283:2686-292.

4. Bonnefoy E., Lapostolle F., Leizorovicz A., et al. Primary angioplasty vs. pre-hospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet 2002;360:825-9.

5. Steg P.G., Bonnefoy E., Chabaud S., et al. Impact of time to treatment on mortality after pre-hospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 2003;108:2851-6.

6. Pinto D.S., Frederick P.D., Chakrabarti A.K., et al. Benefit of transferring ST-segment-elevation myocardial infarction patients for percutaneous coronary intervention compared with administration of onsite fibrinolytic declines as delays increase. Circulation 2011;124:2512-21.

7. Boersma E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J 2006;27:779-88.

8. Van de Werf F., Bax J., Betriu A., et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J 2008; 29:2909-45.

9. Pinto D.S., Kirtane A.J., Nallamothu B.K., et al. Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation 2006;114:2019-25.

10. Bjorklund E., Stenestrand U., Lindback J., et al. Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with STelevation myocardial infarction. Eur Heart J 2006;27:1146-52.

11. Van De Werf F., Adgey J., Ardissino D., et al. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double- blind randomised trial. Lancet 1999;354:716-22.

12. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. The GUSTO investigators. N Engl J Med 1993; 329:673-82.

13. White H.D. Thrombolytic therapy in the elderly. Lancet 2000;356:2028-30.

14. Danchin N., Coste P., Ferrieres J., et al. Comparison of thrombolysis followed by broad use of percutaneous coronary intervention with primary percutaneous coronary intervention for ST-segment-elevation acute myocardial infarction: data from the French registry on acute ST-elevation myocardial infarction (FAST-MI). Circulation 2008;118:268-76.

15. Kalla K., Christ G., Karnik R., et al. Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry). Circulation 2006;113:2398-405.

16. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet 2006;367:569-78.

17. Armstrong P.W., Gershlick A.H., Goldstein P., et al. Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction. N Engl J Med 2013;368:1379-87.

18. O’Gara P.T., Kushner F.G., Ascheim D.D., et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:e78-e140.

19. Armstrong P.W., Boden W.E. Reperfusion paradox in ST-segment elevation myocardial infarction. Ann Intern Med 2011;155:389-91.

20. Roe M.T., Messenger J.C, Weintraub W.S., et al. Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. J Am Coll Cardiol 2010;56:254-63.

21. Kaul S., Diamond G.A., Weintraub W.S. Trials and tribulations of non-inferiority: the ximelagatran experience. J Am Coll Cardiol 2005;46:1986-95.

22. Brouwer M.A., Martin J.S., Maynard C., et al. Influence of early prehospital thrombolysis on mortality and event-free survival (the Myocardial Infarction Triage and Intervention [MITI] Randomized Trial). Am J Cardiol 1996;78:497-502.

23. Westerhout C.M., Bonnefoy E., Welsh R.C., et al. The influence of time from symptom onset and reperfusion strategy on 1-year survival in ST-elevation myocardial infarction: a pooled analysis of an early fibrinolytic strategy versus primary percutaneous coronary intervention from CAPTIM and WEST. Am Heart J 2011;161:283-90.

24. Van de Werf F., Barron H.V., Armstrong P.W., et al. Incidence and predictors of bleeding events after fibrinolytic therapy with fibrin-specific agents: a comparison of TNK-tPA and rt-PA. Eur Heart J 2001;22:2253-61.


For citations:

Gilyarevskiy S.R., Golshmid M.V., Kuz'mina I.M. Use of pharmacoinvasive approach to the treatment of patients with ST segment elevation acute coronary syndrome: state of the problem. Rational Pharmacotherapy in Cardiology. 2015;11(6):643-649. (In Russ.)

Views: 735

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)