What are the strategies for use of percutaneous coronary intervention (PCI) to treat STEMI?

Updated: Nov 27, 2019
  • Author: George A Stouffer, III, MD; Chief Editor: Karlheinz Peter, MD, PhD  more...
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Answer

The recognition that intracoronary thrombosis from a ruptured plaque is the primary cause of vessel occlusion in STEMI and that prompt restoration of vessel patency provides significant clinical benefit has led to the development of two main reperfusion strategies.

Thrombolytic therapies, such as front-loaded tissue plasminogen activator (t-PA), reteplase (r-PA), and tenecteplase (TNK), open approximately 60-80% of infarct-related vessels within 90 minutes, but only 50% of these vessels will have normal (TIMI grade 3) flow. In addition, 10% of vessels opened by thrombolysis either become reoccluded or are the source for recurrent symptoms of angina. Also, patients older than 75 years, who have the most to gain from reperfusion, have unacceptably high rates of intracerebral hemorrhage with thrombolysis.

Because of these limitations, several randomized trials have evaluated mechanical revascularization with primary angioplasty in the setting of STEMI. The advantage of this approach is that the artery can be opened more frequently (>95%), and the underlying plaque rupture can be treated.


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