Wilhelm Grander
A k u t e r S T- S t r e c k e n h e b u n g s i n f a r k t im Gebirge – Thrombolyse versus Primär-PTCA Acute ST- Elevation Myocardial Infarction in Mountainous Terrain – Thrombolysis Versus Primary PTCA
S U M M A RY Mountain sports and mountain tourism is world wide increasing. 15 % of all the people who reflect the known epidemic cardiovascular burden, will account for the older population. Therefore sudden cardiac death and acute coronary syndromes are frequently recognized in the mountains. One third of all deaths in the mountains is caused by sudden cardiac death. Therefore it is an important question how to treat acute myocardial infarction in mountain areas. The potential value of prehospital thrombolysis is well documented by the results of a meta-analysis of six randomized trials involving 6434 patients. Three significant benefits were noted with prehospital compared to in-hospital thrombolysis: First a shorter time to thrombolysis (104 versus 162 minutes). Second a reduced all-cause hospital mortality (odds ratio 0.83, 95 percent CI 0.70 to 0.98) and third an absolute risk reduction of almost 2 percent translated into one life saved for every 62 patients treated with prehospital thrombolysis. Initial studies suggested no benefit and possible harm from early percutaneous coronary intervention (PCI) if thrombolytic therapy were given first. However, PCI techniques have been improved and recent trials demonstrate a wider role for thrombolysis combined with PCI as a form of rescue PCI, if thrombolysis suggests a not optimal result. Therefore even when PCI is the more successful approach in opening the vessel, thrombolysis has still its value in an optimal time setting. If the marker of early reperfusion by thrombolysis are not fulfilled rescue PCI should be attempted within 2 hours. Keywords: Acute Myocardial Infarction, STEMI, prehospital thrombolysis, PTCA
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