František Kovář
The underlying cause of ST segment elevation myocardial infarction (STEMI) is, in most cases, acute closure of the
infarct related coronary artery (IRA). The basic treatment is therefore an immediate reperfusion therapy, which allows
the restoration of the coronary artery blood flow and salvage of the jeopardized myocardium. Primary percutaneous
coronary intervention (PPCI) is the most effective reperfusion therapy, provided this procedure is performed by an experienced
team, and it is initiated early. The current recommendations set the maximum delay from STEMI diagnosis
to IRA opening with PPCI for 120 minutes. If it is assumed that this time interval is to be exceeded, fibrinolytic therapy
(FL) should be applied as soon as possible. FL agent must be administered within 10 minutes from STEMI diagnosis.
In the context of pharmacoinvasive approach, patients after FL are then transferred to a cardio-center, where
invasive diagnosis and intervention treatment (according to fibrinolysis effects such as as rescue or routine) are subsequently
performed. A bypass revascularization procedure is (due to its increased surgical mortality) indicated only
in a small percentage of patients with STEMI.