Primary coronary intervention in acute myocardial infarction

Percutaneous coronary intervention (PCI) with stent implantation has become the standard of care for acute myocardial infarction <12 hours from symptom onset. This has led to decreased morbidity and mortality both short and long term compared to thrombolytic therapy. Stent implantation has been demonstrated to be superior to balloon PCI for mechanical reperfusion of acute myocardial infarction. Intravenous antiplatelet glycoprotein IIb/IIIa inhibitors may have a role in improving TIMI flow prior to PCI and decreasing morbidity and mortality. The role of thrombolytics vs. IIb/IIIa inhibitors in "facilitated reperfusion" is unclear at this time and further research is needed to define the indication of adjunctive pharmacology.