Prehospital Thrombolysis-Time is Muscle and Muscle is Time

Although the medical and technological revolution in the last three decades has improved clinical outcome in patients presenting with acute STEMI, residual morbidity and mortality are still high. It is widely acknowledged that the key factor in the successful treatment of AMI is the time elapsed between the onset of symptoms and initiation of therapy. The obvious step in the continuing effort to shorten time-to-treatment and thus to achieve maximal myocardial salvage is the use of prehospital thrombolysis. According to the mortality data, pre-hospital and also in-hospital thrombolysis has success rates comparable with Pri.PCI when initiated within the first 2–3 h after the onset of pain. Therefore, in these patients, thrombolytic therapy should not be withheld in favor of mechanical reperfusion if it cannot be offered within 90 min.