Percutaneous coronary intervention in st-elevation myocardial infarction.

This review traces the development of coronary angioplasty as a direct, primary means of establishing reperfusion in an acutely occluded infarct-related artery. As a therapeutic strategy for the early management of patients with ST-elevated acute myocardial infarction, this mechanical-invasive procedure arose virtually simultaneously with the demonstration that intravenous administration of fibrinolytic agents to such patients results in a relative reduction in early mortality by as much as 25% to 30%. Over the past 15 years, more than a dozen randomized, controlled trials have investigated the question, "Which is the better means of administrating reperfusion therapy?" The recent demonstration that the combination of coronary stenting plus glycoprotein IIb/IIIa inhibitors used in the early stages of ST-elevation acute myocardial infarction salvages more myocardium than the administration of front-loaded tissue plasminogen activator offers a convincing answer. This is further supported by the evidence that clinical outcomes also improved in these patients, with the greater improvement in ventricular function. It is likely, however, that the development of newer pharmacologic agents plus the combination of both strategies will keep this a hotly debated issue for some time to come.