Facilitated percutaneous coronary intervention: current concepts, promises, and pitfalls

Area of Science:

• Cardiology
• Interventional Cardiology
• Emergency Medicine

Background:

• The reperfusion era has transformed ST-segment elevation myocardial infarction (STEMI) management.
• Following fibrinolysis for STEMI, treatment strategies like facilitated percutaneous coronary intervention (PCI), pharmacoinvasive approach, and watchful waiting are debated.

Purpose of the Study:

• To critically appraise the current literature on facilitated PCI following fibrinolysis for STEMI.
• To evaluate the role and effectiveness of facilitated PCI in contemporary STEMI management.

Main Methods:

• Literature search of Medline for English-language articles on facilitated PCI.
• Inclusion of randomized controlled trials, meta-analyses, and review articles.
• Critical appraisal of available data on facilitated PCI in STEMI.

Main Results:

• Facilitated PCI using thrombolytic agents has no established role in routine clinical practice for STEMI.
• Facilitated PCI with glycoprotein IIbIIIa inhibitors offers no significant mortality benefit in contemporary STEMI management.
• Fibrinolytic-facilitated PCI is linked to higher mortality and adverse events compared to primary PCI.

Conclusions:

• Facilitated PCI after fibrinolysis is not supported by current evidence for STEMI management.
• Primary PCI remains the preferred strategy for reperfusion in STEMI.
• Further research may be needed to clarify the role of specific facilitated PCI strategies, if any.