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To the Editor: The optimal treatment strategy for patients with STEMI without contraindications to thrombolysis when delay to primary PCI exceeds 90 minutes has been controversial.¹ In their study of data from the RIKS-HIA, Dr Stenestrand and colleagues² report a decrease in 30-day and 1-year mortality in patients treated with primary PCI compared with prehospital thrombolysis and in-hospital thrombolysis. The superiority of PCI was also sustained in patients with chest pain onset within 2 hours. The authors concluded that lytic therapy should only be considered for patients with pain onset within 2 hours and when transport delay to primary PCI exceeds 4 hours. In our opinion this conclusion is premature.

In this registry, patients who received primary PCI were low risk. The median delay for PCI compared with prehospital thrombolysis and in-hospital thrombolysis was 90 and 43 minutes, respectively. However, for patients treated within the first 2 hours of chest . . . [Full Text of this Article]

Jacek Legutko, MD, PhD
jlegutko@cathlab.krakow.pl

Zbigniew Siudak, MD; Dariusz Dudek, MD, PhD; Lukasz Rzeszutko, MD, PhD
Institute of Cardiology
Jagiellonian University
Krakow, Poland

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