Heart disease has become a leading cause of death in the United States. The classification for heart disease is broad and covers several different types of ailments, including congenital heart disease, coronary artery disease (CAD), and myocardial infarction. This paper will focus on myocardial infarction (MI), commonly known as a heart attack. MI occurs when there is a blockage of blood flow to a section of the heart muscle. The obstruction of blood flow can be caused by a sudden contraction or constriction of a coronary artery, or by a blood clot within the coronary artery.

Research indicates that percutaneous coronary intervention (PCI) is currently the primary treatment for ST-segment myocardial infarctions (STEMI). However, not all hospitals and clinics are equipped to perform PCI, making fibrinolytic therapy the secondary option for those facilities. Many medical centers worldwide still rely on fibrinolytic therapy, as prompt reperfusion following an MI is critical. Fibrinolysis therapy is advised as a supplemental treatment within thirty minutes of arrival at a facility that is unable to perform PCI.

The Get With the Guidelines- Coronary Artery Disease (GWTG-CAD) database provides clinical data on patients' statistics, lab results, initial hospital symptoms, previous medical histories, and therapies at the time of release. Out of the total population of 235,000 patients registered with the GWTG-CAD program from 2003 to 2008, 29,000 individuals with a clinical diagnosis of CAD were selected as the sample size. The study identified that fibrinolysis therapy for STEMI has decreased over the past five years as PCI becomes more common. However, skills deterioration has significantly delayed fibrinolytic therapy timeliness, which has not improved with time.

In conclusion, fibrinolytic therapy is still in use in many facilities worldwide due to a lack of PCI equipment or access. However, research suggests that fibrinolytic therapy's effectiveness could be enhanced when it is utilized in tandem with another treatment to address the time constraints of treating MI appropriately and promptly. Further studies are necessary to develop a comprehensive approach to treating MI in situations where PCI is not available.

In instances of sufficient time, patients with ST-segment elevation myocardial infarction (STEMI) are often referred to percutaneous coronary intervention (PCI) centers. The University of Kentucky’s Institutional Review Board for the Chandler Medical Center College of Medicine approved a study that was conducted at the medical center. Between July 1, 2009, and June 30, 2011, 191 STEMI patients from all over Kentucky visited the University of Kentucky Chandler Medical Center during the study’s timeframe. This is because it is one of the biggest academic medical centers in the state and treats patients from various parts of Kentucky. Data for this study was derived from the National Cardiovascular Data Registry (NCDR) database, which contains patient demographics, lab outcomes, major hospitalization diagnoses, previous medical histories, and treatments at the time of release. Key performance metrics were monitored during crucial instances.

Of the 191 STEMI patients who sought care at the UK hospital, 82 received no care at another facility, leaving only 109 individuals. Of those 109 patients, 82 were admitted to the hospital and were treated with PCI. Of the 27 patients who received fibrinolytic therapy, 17 eventually required PCI. This study found that the time to reperfusion is correlated with patient mortality in people with STEMI. In the United States, physicians must determine whether to transfer patients to a PCI facility or begin fibrinolytic therapy immediately.

In conclusion, timely administration of PCI in a hospital setting is significantly more effective than fibrinolytic treatment. Fibrinolytic therapy is always useful in the treatment of STEMI when there is no means of getting to a PCI facility. Trials using various techniques in conjunction with fibrinolytic therapy have been conducted to ensure that patients are appropriately and quickly treated, but skews still favor PCI treatment. The decision to move to a PCI facility or administer fibrinolytic therapy must be made at the discretion of the treating physician.

References

Bundhun, P. K., Janoo, G., & Chen, M.-H. (2016). Bleeding events associated with fibrinolytic therapy and primary percutaneous coronary intervention in patients with STEMI. Medicine, 95(23), e3877. https://doi.org/10.1097/md.0000000000003877

Centers for Disease Control and Prevention. (2022). Leading causes of death. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Hira, R. S., Bhatt, D. L., Fonarow, G. C., Heidenreich, P. A., Ju, C., Virani, S. S., Bozkurt, B., Petersen, L. A., Hernandez, A. F., Schwamm, L. H., Eapen, Z. J., Albert, M. A., Liang, L., Matsouaka, R. A., Peterson, E. D., & Jneid, H. (2016). Temporal Trends in Care and Outcomes of Patients Receiving Fibrinolytic Therapy Compared to Primary Percutaneous Coronary Intervention: Insights From the Get With The Guidelines Coronary Artery Disease (GWTG‐CAD) Registry. Journal of the American Heart Association, 5(10). https://doi.org/10.1161/jaha.116.004113

Kadakia, M. B., Rao, S. V., McCoy, L., Choudhuri, P. S., Sherwood, M. W., Lilly, S., Kobayashi, T., Kolansky, D. M., Wilensky, R. L., Yeh, R. W., & Giri, J. (2015). Transradial Versus Transfemoral Access in Patients Undergoing Rescue Percutaneous Coronary Intervention After Fibrinolytic Therapy. JACC: Cardiovascular Interventions, 8(14), 1868–1876. https://doi.org/10.1016/j.jcin.2015.07.028

The article titled "Fibrinolytic Therapy vs. Primary Percutaneous Coronary Interventions for ST-Segment Elevation Myocardial Infarction in Kentucky" written by Wallace, E.L. et al. in 2013 was published in the Southern Medical Journal. The study aimed to compare and analyze the effectiveness of fibrinolytic therapy and primary percutaneous coronary interventions (PPCI) for the treatment of ST-segment elevation myocardial infarction (STEMI) in the state of Kentucky.

The research gathered data from patients with STEMI admitted to hospitals across Kentucky from 2008 to 2010. A total of 890 patients were examined, with 438 receiving fibrinolytic therapy and 452 undergoing PPCI. The study found that PPCI had a higher success rate in restoring blood flow in blocked arteries and reducing mortality rates compared to fibrinolytic therapy. Patients who underwent PPCI had a lower risk of reinfarction, stroke, and bleeding complications.

The study also observed that patients who received fibrinolytic therapy had longer door-to-treatment times, which lowered the chances of a successful outcome. Moreover, patients who underwent PPCI were more likely to receive adjunctive therapies, such as glycoprotein inhibitors and beta-blockers, than those who received fibrinolytic therapy.

In conclusion, the study suggested that PPCI was a more effective treatment option for patients with STEMI than fibrinolytic therapy in the state of Kentucky. The findings of the study highlighted the importance of reducing door-to-treatment times for STEMI patients and emphasizing the use of adjunctive therapies to improve outcomes.