State of the Art in Facilitated Percutaneous Coronary Intervention in the Setting of Acute Myocardial Infarction

Duane S. Pinto, MD, Julian M. Aroesty, MD, Matthew R. Reynolds, MD, C. Michael Gibson, MS, MD

Disclosures

Cardiovasc Rev Rep. 2003;24(5) 

In This Article

Abstract and Introduction

The two dominant approaches in the management of acute ST-segment elevation myocardial infarction are primary percutaneous coronary intervention and fibrinolytic therapy. Each approach has seen significant advances during the last several decades that have translated into improved survival rates. Despite the widespread availability and ease of fibrinolytic administration, this strategy is limited by unacceptable rates of intracerebral hemorrhage, ineffective reperfusion, and reinfarction. Primary percutaneous coronary intervention, on the other hand, is more reliable in restoring normal epicardial blood flow, but is not available in all centers, reducing its time-dependent benefits. Preliminary studies combining pharmacologic and mechanical approaches have demonstrated improved epicardial and microvascular function.

Nearly 25 years ago, Dr. Keith Reimer and colleagues[1] described the wavefront of necrosis that occurs following coronary artery occlusion. Potential consequences of this myocardial necrosis are subsequent ventricular dysfunction and/or arrhythmia. The two general approaches that have been developed for the management of the thrombotic occlusions causing acute myocardial infarction (AMI) are fibrinolytic therapy and primary percutaneous coronary intervention (PCI). While recent advances in both strategies have occurred, limitations remain. Indeed, in an effort to overcome their respective limitations, the two therapies can be combined in a strategy termed "facilitated PCI." Though often viewed as alternative or competing therapies, fibrinolysis and PCI when appropriately combined may actually produce better results than either alone.

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