Acute myocardial infarction and acute stroke: What are the differences? Focus on reperfusion therapy
Abstrakt
This review compares acute myocardial infarction and acute stroke- their similarities and differences. The focus is given on reperfusion therapy: pharmacologic, mechanical or combined.
The key trials and metaanalyses are described. The published data on iv. thrombolysis show, that even among a subgroup of patients treated within 90 min from stroke onset the trend to lower mortality is not significant and in all other subgroups (i.e. treated after >90 min) there is a trend towards increased mortality with thrombolytic treatment.
The data on combined therapy demonstrate, that there is no benefit from facilitated intervention (iv. thrombolysis followed by ia. thrombolysis +- catheter intervention) over iv. thrombolysis alone in acute stroke. This is very similar to the situation in acute myocardial infarction 25 years ago (intracoronary thrombolysis was not superior to intravenous thrombolysis) or more recently (facilitated PCI was not shown to be superior in several trials).
The latest generation of stent retrievers is able to recanalize >70% of occluded intracranial arteries-approximately twice more compared to thrombolysis. However, it is not yet known whether this translates to better clinical outcomes.
The sufficient data on clinical outcomes after primary catheter-based thrombectomy (without thrombolysis) are still missing and trials comparing iv. thrombolysis versus primary catheter-based thrombectomy are urgently needed. The future trials in acute stroke may follow the way paved by acute myocardial infarction trials.
If such trials would demonstrate superiority of catheter-based thrombectomy, we can face in future similar revolution in acute stroke treatment as we have been facing in acute MI treatment in the past years.