Acute MI: How to avoid pitfalls in reperfusion therapy

Thrombolytic therapy must be initiated within 12 hours of the onset of acute myocardial infarction (MI) - within 6 hours for optimal outcome. Thrombolytic therapy is appropriate for most patients whose ECG demonstrates ST-segment elevation or new left bundle branch block, whose blood pressure is lower than 180/100 mm Hg, and who have no history of hemorrhagic stroke. Primary percutaneous transluminal coronary angioplasty poses a lower risk of intracranial hemorrhage and has a higher initial reperfusion rate than thrombolytic therapy. However, angioplasty must be initiated within 90 to 120 minutes of a patient's arrival in the emergency department.