Fibrinolysis is the best first option for patients presenting to hospitals with ST-segment elevation myocardial infarction (STEMI) in cases where immediate percutaneous coronary intervention (PCI) is not available, researchers say.

The intervention should be followed by PCI between two and 24 hours later, they say.

The findings should help with treatment decisions for rural patients and others without easy access to a hospital providing PCI.

The US-led network meta-analysis included 31 trials comparing at least two of four reperfusion strategies for STEMI: primary PCI (6139 patients), fibrinolysis alone (4212 patients), fibrinolysis followed by PCI within two hours of fibrinolytic therapy (2259) and fibrinolysis followed by PCI between 2 and 24 hours later (2747).