Controversy continues in the United States over the performance of percutaneous coronary intervention (PCI) at facilities without on-site cardiac surgery. After publication of the quantitative review by Keeley et al1 in 2003, the superiority of PCI over thrombolytic therapy for the treatment of ST-segment–elevation myocardial infarction (STEMI) was widely accepted. These findings further suppor...

Primary percutaneous coronary intervention (PCI) has been demonstrated to be superior to fibrinolytic therapy in reducing mortality in ST-segment elevation myocardial infarction (STEMI) when it can be performed rapidly. However, many STEMI patients present to hospitals without PCI capability and often cannot undergo PCI within the guideline-recommended timelines; instead, they receive fibrinoly...

D uring the past decade, advances in device technology (eg, drug-eluting stents), development of safer antico-agulants (eg, bivalirudin), and refinement in procedural techniques have led to a dramatic improvement in the effectiveness and safety of percutaneous coronary intervention (PCI), despite increasing clinical and anatomic complexity of treated patients. 1 As safety and effectiveness have...

CONTEXT Trials comparing primary percutaneous coronary intervention (PCI) and thrombolytic therapy for treatment of acute myocardial infarction (MI) suggest primary PCI is the superior therapy, although they differ with respect to the durability of benefit. Because PCI is often limited to hospitals that have on-site cardiac surgery programs, most acute MI patients do not have access to this the...

Background: There are no randomized trials described outcomes of multivessel percutaneous coronary interventions (PCI) (in primary and staged revascularization) with second generation drug eluting stents (DES) in patients with ST-elevation myocardial infarction (STEMI). We are presenting preliminary results of randomized trial (NCT01781715). Methods: Six-month outcomes of 89 consecutive patient...

In patients with stable CAD, PCI can be considered a valuable initial mode of revascularization in all patients with objective large ischaemia in the presence of almost every lesion subset, with only one exception: chronic total occlusions that cannot be crossed. In early studies, there was a small survival advantage with CABG surgery compared with PCI without stenting. The addition of stents a...

As the population ages the number of elderly patients presenting with acute myocardial infarction (AMI) will continue to increase. There has been no head-to-head trial of thrombolytic therapy versus primary percutaneous coronary intervention (PCI) in this patient cohort, but there is evidence that favors primary PCI. Most elderly patients are candidates for primary PCI, but many have contraindi...

BACKGROUND Previously published evidence on ischemic mitral regurgitation (IMR) and its adverse prognosis after myocardial infarction has been based on the severity of IMR in the subacute or chronic period of myocardial infarction. However, the state of IMR can vary from the early stage to the chronic stage as a result of various responses of myocardium after primary percutaneous coronary inter...

AIMS N-terminal pro-brain natriuretic peptide (NT-proBNP) levels predict outcomes in ST-elevation myocardial infarction patients treated with fibrinolysis or primary percutaneous coronary intervention (PCI). However, its role in facilitated PCI has not yet been assessed; it may be a tool to evaluate the lower event rates with primary PCI in ASSENT-4. METHODS AND RESULTS In ASSENT-4, 1667 pati...

Hospital transfer is associated with delays in performance of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction. Given the limited number of interventional centers in the United States, the transfer of patients is widely practiced. We compared the outcome of patients who were transferred for primary PCI and determined whether prolonged door-to-balloon times...