1Dr.Faisal Nadeem, 2Dr Khalil Abbas, 3Dr Muhammad Shahzad, 4Dr Hafiz Furqan Ahmad, 5Dr Sheraz Aslam,

Comparison of Primary Percutaneous Coronary Intervention Versus Thrombolytic Therapy in ST-Elevation Myocardia Infarction

Abstract:

ST-elevation myocardial infarction (STEMI) is an acute coronary syndrome caused by sudden coronary artery occlusion and requires rapid restoration of myocardial blood flow. Primary percutaneous coronary intervention (PPCI) and thrombolytic therapy are established reperfusion strategies, but their relative effectiveness depends on treatment availability, timing, contraindications, and patient characteristics.The study aimed to compare primary percutaneous coronary intervention with thrombolytic therapy for STEMI and to evaluate their relative effects on mortality, recurrent myocardial infarction, stroke, bleeding, and successful myocardial reperfusion.A comparative clinical evidence-based framework was used to evaluate outcomes associated with PPCI and thrombolytic therapy in patients with STEMI. Evidence concerning
mortality, reinfarction, stroke, bleeding complications, recurrent ischemia, and reperfusion success was assessed using randomized trials, systematic reviews, meta-analyses, and contemporary clinical guidelines.PPCI was associated with more reliable coronary reperfusion and lower risks of mortality, reinfarction, recurrent ischemia, and stroke compared with thrombolytic therapy when timely PCI was available. Thrombolytic therapy remained an important alternative when PPCI could not be performed within the recommended time window. Fibrinolysis carried a greater risk of intracranial and other bleeding complications, whereas PPCI was associated with procedure-related risks and depended on rapid access to an experienced catheterization laboratory.PPCI generally provides superior clinical outcomes compared with thrombolytic therapy for STEMI when it can be performed promptly. Thrombolytic therapy remains appropriate when timely PPCI is unavailable and can be followed by early angiography and PCI when indicated. The choice of reperfusion strategy should therefore prioritize rapid restoration of coronary blood flow while considering treatment delay, bleeding risk, contraindications, and healthcare-system capabilities.

Key words
ST-elevation myocardial infarction; primary percutaneous coronary intervention; thrombolytic
therapy; fibrinolysis; reperfusion; myocardial infarction; coronary revascularization; mortality;
stroke.

GlobalHealth & Medicine. 2026; 8(3):384-395. Original Article
DOI:10.35772/ghm.2026.01073

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