Recent advances in primary percutaneous intervention for acute myocardial infarction.

I nterventional cardiology has evolved since the first studies comparing primary percutaneous intervention (PPCI) and intravenous thrombolysis for the treatment of ST segment elevation myocardial infarction (STEMI). Indeed it may now seem remarkable that in an era where abrupt vessel closure and restenosis occurred routinely in up to 8% and 40%, respectively, 2 plain balloon angioplasty was able to demonstrate significant improvements in short and long term outcome relative to thrombolysis. 4 This emphasises the prognostic importance of restoring effective flow in the culprit vessel as early as possible, for which PPCI has been highly effective from the outset. However, the corollary is that despite major advances in stent technology and adjuvant pharmacology since that time, the absolute outcome benefits of PPCI remain definite but modest. Here we put into context some of the recent advances in the field of PPCI, highlighting key questions that are yet to be answered, and speculate on what the future may offer as this therapy secures its place as the preferred treatment strategy for STEMI.