When is thrombolytic therapy used for reperfusion in the setting of a STEMI?

Thrombolytic therapy is utilized for reperfusion in the context of a STEMI primarily when percutaneous coronary intervention (PCI) is not an option or when there is a delay in its availability. This is because thrombolytics work by dissolving the blood clots that obstruct coronary arteries, which restores blood flow to the heart muscle and limits damage.

In situations where immediate PCI is either unavailable (due to logistical issues, e.g., distance to a PCI-capable facility or the need for an emergency procedure) or delayed (such as a longer transport time), thrombolytic therapy can be life-saving. It is critical to administer thrombolytics swiftly, ideally within the first few hours of the onset of myocardial ischemic symptoms, to maximize efficacy and minimize complications.

Other scenarios mentioned, such as a previous myocardial infarction, recent coronary artery bypass grafting (CABG), or stable angina, do not warrant the use of thrombolytic therapy. For example, thrombolytics are generally contraindicated post-CABG due to the increased risk of bleeding and are not intended for stable angina, as this condition does not typically involve acute coronary occlusion requiring urgent intervention.