Current reperfusion strategies for ST elevation myocardial infarction: a Canadian perspective

The goal of reperfusion therapy for ST elevation myocardial infarction is to achieve prompt and sustained patency of the infarct-related artery. Fibrinolytic therapy is quickly available but it successfully restores flow only in approximately 60% of cases. Percutaneous coronary intervention (PCI) is successful in over 90% of cases but requires timely availability of an experienced interventional team. Although individual trials do not show a clear mortality benefit with PCI, a recent analysis of 23 trials comparing PCI with fibrinolytic therapy showed PCI was associated with improved survival. PCI is also associated with less recurrent ischemia, reinfarction, stroke, target vessel revascularization and a shorter hospital stay. Facilitated PCI attempts to optimize the benefits of pharmacological and mechanical reperfusion by giving a pharmacological agent initially, hoping for reperfusion while an emergency PCI is organized. The literature regarding pharmacological and mechanical reperfusion is reviewed to emphasize the important issues while a future strategy of facilitated PCI is contemplated.