Primary percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: does the choice of fibrinolytic agent impact on the importance of time-to-treatment?

The mortality benefit associated with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction may be lost if door-to-balloon time is delayed by >1 hour compared with tissue plasminogen activator therapy door-to-needle time. When a substantial delay in initiating primary PCI is likely, reperfusion therapy with second- or third-generation fibrinolytic agents should be strongly considered.