Primary percutaneous coronary intervention at hospitals without on-site cardiac surgery: expanding the use of mechanical reperfusion for acute myocardial infarction.

echanical reperfusion was introduced as a reperfusion trategy for ST-segment elevation acute myocardial infarcion (AMI) in the midand late 1980s and offered advanages over thrombolytic therapy in achieving higher infarct rtery patency rates with less re-occlusion. With the publiation of the Zwolle and PAMI trials in 1993 (1,2), which ocumented superior outcomes with primary percutaneous oronary intervention (PCI) over thrombolytic therapy, rimary PCI became a legitimate competing reperfusion trategy at interventional facilities with experienced operaors. There are now over 23 randomized trials documenting he superiority of mechanical reperfusion over thrombolytic herapy (3), and primary PCI has become the preferred eperfusion strategy when experienced operators can perorm it in a timely manner. However, the use of primary CI has been limited owing to the lack of interventional acilities at most hospitals and the reluctance of physicians o transfer patients with AMI who present at community ospitals to interventional facilities because of concerns bout the deleterious effects of treatment delay on myocarial salvage and clinical outcomes. This has stimulated new trategies to provide primary PCI to patients presenting to on-interventional hospitals.