The most serious and severe type of heart attack is the ST elevation myocardial infarction (STEMI). In this type of heart attack, a coronary artery is completely blocked by a blood clot. In order to save heart muscle from dying, it is essential to open the affected artery as quickly as possible. The two approaches to opening such an artery are with a “clot buster” medication, or thrombolytic, and with the balloon and stent procedure, or angioplasty.
It is commonly accepted that the balloon and stent approach is better than thrombolytics if compared head-to-head. Unfortunately, hospitals with the necessary facilities and staff for this procedure are often not available. In this case, thrombolytics are the chosen approach.
Why Are Doctors Not Combining Thrombolytics and Angioplasty
Many studies have evaluated whether these two methods be combined in a person suffering from an STEMI. This approach improves blood flow through the blocked artery. However, bleeding risk increases. It turns out that the greater bleeding risk outweighs the benefit of better blood flow.
Additionally, using a thrombolytic first has the potential of delaying angiography and the balloon and stent procedure. Ideally, an artery should be opened with a balloon within 90 minutes of arriving at a hospital.
Sources:
Ellis SG, Tendera M, de Belder MA, et al. Facilitated PCI in patients with ST-elevatino myocardial infarction. New England Journal of Medicine 2008;358.
Leopold JA. Does Thrombolytic Therapy Facilitate or Foil Primary PCI? New England Journal of Medicine 2008;358.