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February 25, 2004

Coupling Drug and Catheter Therapy for Myocardial Infarction

JAMA. 2004;291(8):1000-1002. doi:10.1001/jama.291.8.1000

Notwithstanding efficacy demonstrated in randomized trials, reperfusion strategies for acute myocardial infarction (MI) remain subject to considerable limitations. A plateau of mortality reduction seemingly has been reached with fibrinolytic therapy,1 a lack of progress that may relate to the apparent "ceiling" of coronary patency achieved with these drugs, reocclusion, or impaired microvascular tissue level reperfusion. Moreover, the catastrophic complication of intracranial hemorrhage continues to occur in up to 1% of patients receiving fibrinolytic agents.1 Mechanical approaches to revascularization with balloon angioplasty or coronary stenting overcome some limitations of pharmacologic reperfusion, as randomized trials comparing fibrinolysis with primary percutaneous coronary intervention (PCI) in general have shown the latter to be associated with lower rates of death or reinfarction and markedly diminished hemorrhagic complications.2

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