Despite dramatic improvements in the treatment of acute ST-segment elevation
myocardial infarction (STEMI) during the past decade, approximately 1 in 10
patients still die of this disease.1 Three
critical factors in the immediate management of patients with STEMI result
in reduced mortality: prompt diagnosis, immediate treatment with aspirin,
and rapid reestablishment of blood flow in the infarct-related artery. The
latter aim may be achieved either pharmacologically, with administration of
thrombolytic therapy, or mechanically, with percutaneous coronary intervention
(PCI). Primary PCI refers to the strategy of emergent angiography followed
by mechanical recanalization of the occluded artery with a balloon catheter,
without prior administration of thrombolytic therapy. In its early years,
the data regarding primary PCI were limited to observational studies from
specialized centers. With the publication of randomized controlled trials
(RCTs) comparing PCI with thrombolytic therapy, however, primary PCI has become
accepted as part of the standard armamentarium in the treatment of STEMI.
The most recent RCTs on this topic have begun to examine the role of primary
PCI in specific subsets of patients with STEMI and the role of adjunctive
therapies in patients undergoing primary PCI.
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