La fibrinolyse préhospitalière et les modalités modernes d'utilisation du traitement fibrinolytique dans l'infarctus du myocarde avec sus-décalage du segment ST

Intravenous fibrinolysis has long been considered a “self-sufficient” treatment of ST-elevation myocardial infarction. As such, its clinical results remain inferior to those of primary percutaneous coronary intervention (PCI). Recent studies, however, have shown that prehospital delivery of intravenous fibrinolysis and its use as part of a pharmaco-invasive strategy (i.e. fibrinolysis followed by rapid coronary angiography and PCI as necessary) gives results superior to those of stand-alone fibrinolytic therapy. Modern registries of real-world practice show that such an approach yields results similar to those of primary PCI. The French system of care, with both a highly developed network of physician-staffed mobile intensive care units and numerous catheterization laboratories, shows that both modalities of reperfusion therapy can be used with equivalent clinical efficacy, and that the choice between both methods should be dictated mostly by timing considerations.