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Published on: January 21, 2018
Facilitated percutaneous coronary intervention in acute myocardial infarction: attractive concept but difficult to
Robert V Kelly1, Mauricio G Cohen, E Magnus Ohman
1Division of Cardiology, The University of North Carolina at Chapel Hill, Cardiac Catheterization Laboratory, Chapel Hill, NC 27517, USA. rkelly@med.unc.edu
Insights
Facilitated percutaneous coronary intervention (PCI) improves outcomes for acute myocardial infarction (AMI) patients by enabling early artery opening before catheterization. This strategy reduces myocardial damage by addressing delays in treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) management is time-sensitive, with delays to reperfusion leading to irreversible myocardial damage.
- Door-to-balloon time is a critical metric, and geographical or logistical challenges can prolong this interval.
- Facilitated percutaneous coronary intervention (PCI) aims to mitigate these delays and improve patient outcomes.
Purpose of the Study:
- To evaluate the efficacy and safety of facilitated PCI strategies in acute myocardial infarction patients.
- To compare different pharmacological pre-treatment regimens prior to PCI.
- To assess the impact of early artery opening on myocardial salvage and clinical outcomes.
Main Methods:
- Facilitated PCI involves administering pharmacological therapies before or during transport to the catheterization laboratory.
- Pharmacological strategies include thrombolytic therapy, glycoprotein IIb/IIIa inhibitors, or combination therapy.
- Angiographic studies assess infarct-related artery patency and clinical outcomes.
Main Results:
- Pre-PCI pharmacological interventions can initiate treatment before patients reach the catheterization lab.
- Combination therapy with thrombolytics and glycoprotein IIb/IIIa inhibitors shows improved artery patency.
- Higher bleeding event rates are associated with combination therapy.
Conclusions:
- Facilitated PCI is a valuable strategy for improving outcomes in acute myocardial infarction.
- Ongoing research is crucial to optimize pharmacological regimens for facilitated PCI.
- Balancing reperfusion efficacy with bleeding risk is essential for patient safety.
Abstract:
Facilitated percutaneous coronary intervention (PCI) refers to a strategy of immediate PCI following the administration of pharmacological therapies in acute myocardial infarction. It has evolved primarily from the time delays (due to geography or logistics) in getting acute myocardial infarction patients to the catheterization laboratory and the associated irreversible loss of myocardial muscle that occurs as door-to-balloon time increases. Facilitated PCI provides an opportunity to start treating many of these patients before they reach the catheterization laboratory and provides an ability to open the infarct-related artery before PCI, which is associated with better outcomes for AMI patients. Pharmacological strategies before PCI include: thrombolytic therapy, glycoprotein IIb/IIIa inhibitor alone, or a combination of thrombolytic therapy plus glycoprotein IIb/IIIa inhibitor. Initial results of angiographic studies show better patency with the latter strategy but at the expense of higher bleeding event rates. Ongoing trials are evaluating different combinations of thrombolytic and glycoprotein IIb/IIIa inhibitor therapy.
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