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Contempo Updates
Clinician's Corner
February 11, 2004

Primary Coronary Intervention for Acute Myocardial Infarction

Author Affiliations

Author Affiliations: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (Dr Keeley); Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Mich (Dr Grines).

 

Contempo Updates Section Editor: Catherine Meyer, MD, Fishbein Fellow.

JAMA. 2004;291(6):736-739. doi:10.1001/jama.291.6.736

Despite dramatic improvements in the treatment of acute ST-segment elevation myocardial infarction (STEMI) during the past decade, approximately 1 in 10 patients still die of this disease.1 Three critical factors in the immediate management of patients with STEMI result in reduced mortality: prompt diagnosis, immediate treatment with aspirin, and rapid reestablishment of blood flow in the infarct-related artery. The latter aim may be achieved either pharmacologically, with administration of thrombolytic therapy, or mechanically, with percutaneous coronary intervention (PCI). Primary PCI refers to the strategy of emergent angiography followed by mechanical recanalization of the occluded artery with a balloon catheter, without prior administration of thrombolytic therapy. In its early years, the data regarding primary PCI were limited to observational studies from specialized centers. With the publication of randomized controlled trials (RCTs) comparing PCI with thrombolytic therapy, however, primary PCI has become accepted as part of the standard armamentarium in the treatment of STEMI. The most recent RCTs on this topic have begun to examine the role of primary PCI in specific subsets of patients with STEMI and the role of adjunctive therapies in patients undergoing primary PCI.

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