Reperfusion strategies for ST-elevation myocardial infarction.

Management of ST-elevation myocardial infarction requires rapid, sustained and early restoration of flow in the infarct-related artery to minimize myocardial damage and to improve clinical outcomes. Primary percutaneous coronary intervention (PCI) is the preferred therapy but is limited by restricted availability and delays in implementation. Fibrinolytic administration is widely available but is limited by its failure to achieve Thrombolysis in Myocardial Infarction grade 3 flow in many patients, re-infarction, and intracranial hemorrhage. A combination approach to reperfusion--facilitated PCI--involves the administration of a pharmacologic agent to improve reperfusion with PCI. The evidence supporting facilitated PCI varies according to the pharmacologic regimen at this time.