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[Facilitated PCI: did the concept fail?].

Hans-Jürgen Rupprecht¹

¹Medizinische Klinik, Klinikum Rüsselsheim, Rüsselsheim. hj.rupprecht@gp-ruesselsheim.de

|March 18, 2008

Summary

Facilitated percutaneous coronary intervention (PCI) did not improve clinical outcomes or mortality, despite increasing artery patency. Increased bleeding risks, including cerebral bleeds, were observed, particularly with full-dose fibrinolysis.

Area of Science:

Cardiovascular Medicine
Interventional Cardiology
Thrombosis Research

Context:

Percutaneous coronary intervention (PCI) is the gold standard for reperfusion therapy.
Antithrombotic pretreatment is considered for patients requiring transfer for PCI.
Facilitated PCI aims to combine fibrinolysis benefits with immediate PCI advantages.

Purpose:

To evaluate the efficacy and safety of facilitated percutaneous coronary intervention (PCI).
To assess the impact of antithrombotic pretreatment on reperfusion and clinical outcomes.
To analyze outcomes from major randomized trials and meta-analyses on facilitated PCI.

Summary:

Facilitated PCI, involving pretreatment with fibrinolytics or glycoprotein IIb/IIIa inhibitors, increased infarct-related artery patency by 20%.

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Despite improved patency, clinical outcomes including mortality, reinfarction, and heart failure rates did not improve.

Facilitated PCI was associated with increased bleeding rates, notably cerebral bleeds, especially with full-dose fibrinolysis.

Impact:

Current guidelines recommend facilitated PCI (class IIb) for high-risk patients with delayed PCI and low bleeding risk.
Full-dose fibrinolysis followed by immediate PCI is not recommended (class III).
Carefully selected patients may benefit from a combination of glycoprotein IIb/IIIa inhibitors and half-dose fibrinolytic.