Which is the best reperfusion strategy for patients with high-risk myocardial infarction?

Systemic thrombolysis and primary percutaneous coronary intervention (PCI) are both effective treatments for acute ST-elevation myocardial infarction. Several randomized trials have shown that primary PCI is superior to thrombolytic therapy in acute myocardial infarction (AMI). Despite these findings, thrombolytic therapy remains an acceptable alternative for most patients, yet it may not be ideal for higher-risk AMI patients. Advanced age, diabetes mellitus, anterior infarction, severe tachycardia, shock and comorbidities are associated with early mortality rates ranging from 10 to 58% in patients treated with thrombolytic agents. This review will examine the data comparing primary PCI and systemic thrombolysis in the different clinical conditions which identify patients at high risk in the setting of AMI.