Critical Review of the Pharmacoinvasive Strategy Versus Primary Angioplasty in Patients with Acute ST-Segment Elevation Myocardial Infarction

Time is Myocardium, more than a phrase or slogan is an implicit reminder for health personnel...

diagnosis was immediate in 77%; half were provided with an emergency procedure, 80% were referred to a second hospital for medical attention; 24.6% were transferred to a third site for their attention. Only 1 in 3 patients started specialized treatment within 5 hours, with respect to treatment, 74% underwent catheterization, 8% thrombolysis and 6% primary angioplasty [3] To reduce the unfortunate mortality from heart disease, it is imperative to apply the pharmacoinvasive strategy (PS) in the patient with STEMI, together with the change in logistics, infrastructure, access to medicines and supplies, and transportation. Centers capable of offering primary PCI 24 hours a day, 7 days a week (24/7) must be in place and started as soon as possible. It is recommended to define an area under observation for the diagnosis and treatment of patients with infarction. Depending on the characteristics of the service, it may be within the shock, resuscitation section or close to it, the area must be directly accessible with a chest pain bed, which will preferably be exclusively for this purpose, being essential to have a 12-lead electrocardiograph in the area (preferably 3-channel), as well as a medical crash cart with cardiopulmonary resuscitation equipment, supplies and first-line drugs [4].
The objective of reperfusion therapy is to restore the coronary had its first description of cardiogenic shock in 1942 by Stead and Elbert and its most common cause is IAMSCESST, likewise 70 years after that first description, CS continues to be the main cause of death in AMI in the hospital stage, its mortality has decreased in the last two decades but remains high, between 40% and 50% despite percutaneous coronary reperfusion, optimal medical therapy and mechanical circulatory support [9]. It also lacks to know clinical variables (cardiovascular risk factors, clinical picture, somatometry, hemodynamics such as mean arterial pressure, cardiac output) as well as laboratory variables to cover not only a population sector but also to have a broader dimension and a coarser universe In addition, there is a lack of information on arrival times, needle gate, balloon gate, to know the time of care and make comparisons, investigation of the time relationship, reperfusion therapy and its result, short and medium term prognosis and within complications, CS as already mentioned previously.
The cited study focused on describing the characteristics of PCI, PTCA, such as vascular accesses: radial, femoral, stent placement, IABP, temporary pacemaker, but it does not describe the thrombolysis used in the pharmacoinvasive therapy of the patients to whom it was administered, that is, the type of fibrinolytic, the dose, etc. is unknown, it would also have been important to know it, having a broad vision of the drugs and conducting research of its repercussion not only at the level of response to treatment but also the prognosis of the patients.
Early coronary reperfusion is the essence of the treatment of Acute Coronary Syndrome (ACS) and the main factor that has contributed to the decrease in mortality in these patients.
Observational studies have shown that when the artery responsible for AMI is open in ACS, regardless of the reperfusion method, mortality is reduced to less than half (75% to 33%) [9].

Conclusion
The implementation of a Pharmacoinvasive strategy should not be only an option but should be implemented as optimal management for rescue in STEMI, since generally the treatment goals are not achieved due to various situations of logistics, resources, infrastructure and geography. maximum if percutaneous coronary intervention is not achieved in the first 120 minutes as