JUNIPER PUBLISHERS - OPEN ACCESS JOURNAL OF CARDIOLOGY & CARDIOVASCULAR THERAPY Opinion One of the main changes occurred in medicine in the last 25 years has been reperfusion treatment in acute myocardial infarction. From management of complications to immediate intervention in STEMI has come a long way. Four decades ago, STEMI treatment pointed to complications management, mainly arrhythmic (Ventricular fibrillation or AV block) or mechanics (cardiogenic shock, VSD, cardiac rupture or expansion). Intervention era started with intracoronary fibrinolysis, which quickly evolved to endovenous approach. Fibrinolytic treatment was a landmark as the beginning of the “reperfusion era” in STEMI. But it also was the beginning of bleeding complications in acute coronary syndromes, and its most dreaded form, intracranial hemorrhage. Streptokinase, the historically (and currently) most used fibrinolytic drug is far from ideal: in addition to a low reperfusion rate (TIMI 3 flo...
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