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 Cigarroa

Research output: Contribution to journalArticle

7 Citations (Scopus)

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 2003
Externally publishedYes

Fingerprint

Coronary Balloon Angioplasty
Reperfusion
Integrin beta3
Platelet Glycoprotein GPIIb-IIIa Complex
Mortality
Thrombolytic Therapy
Microvessels
Left Ventricular Function
Arteries
Research Personnel
Safety
Incidence
Therapeutics
ST Elevation Myocardial Infarction

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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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.",
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