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Facilitated percutaneous coronary intervention.

William B Borden1, David P Faxon

  • 1Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA.

Journal of the American College of Cardiology
|September 19, 2006
PubMed
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Primary angioplasty is the preferred treatment for ST-segment elevation myocardial infarction. Facilitated angioplasty, combining thrombolysis with angioplasty, shows no advantage and may increase risks compared to primary angioplasty.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Interventional Cardiology

Background:

  • ST-segment elevation myocardial infarction (STEMI) requires rapid reperfusion.
  • Primary angioplasty is superior to thrombolysis if timely and performed by experienced teams.
  • Timely primary angioplasty is often unachievable due to various factors.

Purpose of the Study:

  • To evaluate the efficacy and safety of facilitated angioplasty strategies in STEMI patients.
  • To compare facilitated angioplasty with primary angioplasty and thrombolysis.
  • To determine if a combined approach improves long-term outcomes in STEMI.

Main Methods:

  • Review of over 17 clinical trials comparing different reperfusion strategies for STEMI.
  • Analysis of trials comparing facilitated angioplasty (thrombolysis + angioplasty) with primary angioplasty.

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  • Focus on major adverse cardiac events, including death, heart failure, and shock.

    • Main Results:

    • Facilitated angioplasty demonstrated more favorable long-term outcomes compared to thrombolysis alone in recent trials.
    • However, trials comparing facilitated angioplasty to primary angioplasty yielded less favorable results.
    • The ASSENT-4 trial indicated a worse outcome with facilitated angioplasty versus primary angioplasty.

    Conclusions:

    • Current evidence suggests facilitated angioplasty offers no benefit over primary angioplasty for STEMI.
    • Facilitated angioplasty strategies may potentially be harmful in STEMI management.
    • Further results from trials like FINESSE are pending, but current data advises caution.