Primary Stenting in Acute Myocardial Infarction

With the demonstration that the timely administration of thrombolytic therapy after coronary arterial occlusion results in myocardial salvage and improved survival, the treatment of patients with evolving AMI has forever been changed. To overcome the inherent limitations of thrombolytic therapy (TIMI 3 flow rates of '55% at best, and rare but unavoidable life-threatening or incapacitating hemorrhagic complications), mechanical reperfusion by balloon angioplasty without antecedent thrombolysis (primary PTCA) has been adopted at many centers. Ten prospective, randomized trials comparing primary PTCA and lytic therapy in 2606 patients have now been performed and examined in a recent meta-analysis by Weaver et al, demonstrating that compared with thrombolytic therapy, primary PTCA results in reduced rates of mortality, reinfarction, and stroke. Other randomized trials have shown that primary PTCA, by reducing early and late recurrent ischemic events and facilitating earlier discharge, is as or more cost-effective than thrombolysis.