Thrombolytic therapy STEMI trial

With advances of adjunctive pharmacotherapy for PCI, multiple trials sought to confirm superiority of primary PCI to thrombolytic therapy in STEMI. In a review of 23 trials, primary PCI had better outcomes than thrombolytic therapy by reducing the combined endpoint of death, nonfatal reinfarction, and stroke (8% versus 14%), independent of the type of the thrombolytic agent used (124). 

Figure 1.4 The importance of time to reperfusion for patients with STEMI is a unifying principal of treatment with primary PCI, thrombolytic therapy, or both. Results in GUSTO 11b trial demonstrate an increase in mortality as a function of delay in door to time of primary PCI. (From Ref. 34.)...

The limitations of thrombolytic therapy for STEMI led to the increasing dominance of the mechanical revascularization strategy, primary PCI. To date, more than 20 randomized trials involving more than 8000 patients have compared primary PCI with thrombolysis. A meta-analysis of these trials convincingly showed that primary angioplasty reduced short-term death (7% vs. 9% p = 0.0002), nonfatal reinfarction (3% vs. 7% p = 0.0004), and stroke (1% vs. 2% p = 0.0004) (16). 

---