Facilitated primary percutaneous transluminal coronary angioplasty for acute ST segment elevation myocardial infarction: Rationale for reuniting pharmacologic and mechanical revascularization strategies

Ellen C. Keeley, Joaquin E. Cigarroa

    Research output: Contribution to journalArticle

    7 Scopus citations

    Abstract

    The primary goal of therapy for acute ST segment elevation myocardial infarction is to preserve left ventricular systolic function and to decrease mortality by achieving rapid, complete, and sustained restoration of blood flow in the infarct-related artery. Early studies assessing the safety and efficacy of combining full-dose thrombolytic therapy with primary percutaneous transluminal coronary angioplasty (PTCA) were disappointing due to an increased incidence of abrupt closure, reinfarction, emergent coronary bypass surgery, and mortality. The observation that the presence of normal coronary blood flow at the time of primary PTCA is an independent predictor of survival coupled with interest in the patency of the downstream microvasculature has prompted investigators to revisit the concept of combining pharmacologic and mechanical strategies. The adjunctive use of pharmacologic therapy with mechanical reperfusion has been coined facilitated primary PTCA and involves the use of reduced-dose thrombolytics, platelet glycoprotein IIb/IIIa inhibitors, or both. The primary goal is to achieve pharmacologic reperfusion before performing definitive mechanical reperfusion. While the preliminary data presented is promising, we must await the results of ongoing large, randomized trials that have been specifically designed to address this question.

    Original languageEnglish (US)
    Pages (from-to)13-20
    Number of pages8
    JournalCardiology in Review
    Volume11
    Issue number1
    DOIs
    StatePublished - Jan 1 2003

    Keywords

    • Acute ST segment elevation
    • Facilitated primary percutaneous transluminal coronary angioplasty
    • Myocardial infarction

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

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