What is reperfusion therapy for acute myocardial infarction?
Reperfusion therapy is a medical treatment to restore blood flow, either through or around, blocked arteries, typically after a heart attack (myocardial infarction (MI)). Reperfusion therapy includes drugs and surgery. The drugs are thrombolytics and fibrinolytics used in a process called thrombolysis.
What are the types of reperfusion therapy?
Reperfusion therapy using thrombolysis, including intravenous (IV) tissue plasminogen activator (tPA) and endovascular interventions such as mechanical thrombectomy (MT), are the only approved treatments for AIS. Both these treatment options have limitations when used as monotherapies.
Why is PCI preferred over Fibrinolytics?
Mechanical revascularization, or primary percutaneous coronary intervention (PPCI), of the infarct artery is the preferred method of restoring coronary perfusion because of its superior efficacy and decreased risk of complications compared with fibrinolytic therapy.
What is myocardial reperfusion?
During myocardial reperfusion, the acute ischemic myocardium is subjected to several abrupt biochemical and metabolic changes, which compound the changes generated during the period of myocardial ischemia.
What should be included in a reperfusion strategy?
Selecting the optimal reperfusion strategy requires customization based on patient factors including time from symptom onset to first medical contact (FMC), the amount of myocardium at risk, the presence of shock or severe heart failure, the risk of bleeding with fibrinolysis, and the time required to perform PCI ( …
What primary reperfusion treatment is preferred for a patient with an acute STEMI who is not a candidate for cardiac catheterization?
Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy for patients presenting with ST-segment elevation myocardial infarction (STEMI) when it can be performed expeditiously and by experienced operators.
Why is PCI preferred over thrombolysis?
Alternatively, PCI is preferred if the medical contact-to-balloon time is less than 90 min and the delta time is less than 60 min, or if there are other reasons (eg, contraindications to thrombolysis, symptom onset of more than 3 h or high-risk STEMI [cardiogenic shock, or Killip class 3 or greater]).
Which is better PCI or thrombolysis?
Primary PCI was superior to thrombolytic therapy in our trial, in the 3 largest previously reported randomized trials,1-3 and in the latest meta-analysis of all randomized trials. Although the incidence of outcomes differs among these studies, the direction of benefit was the same, all favoring primary PCI.
What should be included in reperfusion strategy?
How do you reperfusion an injury?
Reperfusion injury results from several complex and interdependent mechanisms that involve the production of reactive oxygen species, alterations in intracellular calcium handling, microvascular and endothelial cell dysfunction, altered myocardial metabolism, and activation of neutrophils, platelets and complement.
Which of following drug is given as reperfusion therapy to MI patient?
Currently, the most relevant treatment options are: streptokinase (1.5MU over 1h), reteplase (2 boluses of 10MU), alteplase (tissue plasminogen activator; t-PA) [100mg over 1.5 hours] and immediate angioplasty.
When is PCI preferred?
PCI is preferred over medical therapy if the patient has; Severe symptoms. Failed medical therapy. High-risk coronary anatomy.
When do you use PCI vs fibrinolysis?
Primary percutaneous coronary intervention (PCI), when performed in a timely manner, is preferred to fibrinolytic therapy for reperfusion therapy during ST‐segment–elevation myocardial infarction (STEMI). However, logistical barriers limit the availability of primary PCI for most patients worldwide.
Is thrombolysis a PCI?
Primary percutaneous coronary intervention (PCI) and thrombolysis are approved therapies in the treatment of ST-elevation myocardial infarction (STEMI). Many clinical trials have shown that primary PCI provides better results than thrombolysis for the STEMI treatment.
How can cardiac reperfusion injury be prevented?
First, optimizing CPR quality is a key component in order to limit reperfusion injury. Second, post-resuscitation care that targets normal oxygenation (avoiding hyper or hyopoxia), normocapnia, and normal blood pressure post ROSC seem to be of major importance.
What are examples of reperfusion injury?
|Example of clinical manifestation
|Hypoxic brain injury; multiple organ failure; acute kidney injury
|Sickle cell disease
|Acute chest syndrome; pulmonary hypertension, priapism, acute kidney injury
|Ischemia and reperfusion during major surgery
What primary reperfusion treatment is preferred for a patient with acute STEMI who is not a candidate for cardiac catheterization?
What is PCI revascularization?
The goals of percutaneous coronary intervention (PCI) for revascularization of patients with coronary artery disease (CAD) are: (1) to improve survival time and/or (2) to relieve symptoms. PCI recommendations in this section have been formulated specifically for patients with stable ischemic heart disease (SIHD).
When do you use thrombolysis vs PCI?
What is reperfusion injury and how do we avoid this?
Reperfusion injury, sometimes called ischemia-reperfusion injury (IRI) or reoxygenation injury, is the tissue damage caused when blood supply returns to tissue (re- + perfusion) after a period of ischemia or lack of oxygen (anoxia or hypoxia).
What primary reperfusion treatment is preferred for a patient with an acute STEMI who is not a candidate for cardiac cath?
What is the immediate intervention for acute myocardial infarction?
All patients with a suspected myocardial infarction should be given aspirin. It is a powerful antiplatelet drug, with a rapid effect, which reduces mortality by 20%. Aspirin, 150-300 mg, should be swallowed as early as possible.
When should PCI be administered?
Primary PCI should be done within 12 h from symptom onset, but even later if symptoms and ST-segment elevation are still there or have been stuttering.
When is PCI recommended for STEMI?
Background: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment–elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia.