'Facilitated' PCI for Acute MI: PCI with Lysis and Platelet Inhibition

In acute myocardial infarction, reperfusion therapy is needed to restore coronary flow and myocardial perfusion. Thrombolytic therapy is widely available and can be administered rapidly but does not achieve the same degree of reperfusion as primary percutaneous coronary intervention (PCI). Glycoprotein (GP) IIb/IIIa inhibitors improve outcomes with primary PCI and with thrombolysis. Although past studies have failed to demonstrate a benefit of routine early PCI after thrombolysis, recent studies suggest that early PCI with stenting is safe and effective after administration of low-dose thrombolytic therapy combined with GP IIb/IIIa inhibition. This strategy, termed 'facilitated' PCI, combines the early benefits of thrombolysis with the higher patency rates and superior clinical outcomes of primary PCI, and is being evaluated in ongoing trials. Facilitated PCI, the fusion of pharmacologic and mechanical reperfusion strategies, may be the optimal initial management for patients with acute myocardial infarction.