Primary angioplasty for acute myocardial infarction--is it worth the wait?

Nearly two decades after clinical trials established that fibrinolytic therapy for acute myocardial infarction preserves left ventricular function and reduces mortality, there is evidence that mechanical reperfusion therapy is superior in reducing the rates of death, reinfarction, intracranial bleeding, reocclusion of the infarct-related artery, and recurrent ischemia. Initially introduced as an alternative to fibrinolytic therapy (to circumvent contraindications to its use and the risk of intracranial bleeding), primary percutaneous coronary intervention is now increasingly recognized as the reperfusion therapy of choice. The ability to restore robust coronary flow promptly in more than 90 percent of patients and the nearly linear relation between patency of the infarct-related artery at 90 minutes after the initiation of reperfusion therapy and in-hospital mortality rates lend credibility to the momentum behind primary percutaneous coronary intervention for patients with myocardial infarction associated with ST-segment elevation. In fact, a quantitative review 1