[Management of acute myocardial infarction. How improve primary angioplasty?]

Area of Science:

• Interventional Cardiology
• Cardiovascular Pharmacology

Context:

• Percutaneous coronary intervention (PCI) aims to rapidly restore blood flow to the myocardium.
• Optimization of PCI techniques is crucial for improving patient outcomes and minimizing complications.

Purpose:

• To review current pharmacological, mechanical, and procedural tools for optimizing PCI.
• To highlight evidence-based strategies for enhancing myocardial reperfusion and reducing adverse events.

Summary:

• Intracoronary administration of antiGP2b3a agents may enhance efficacy in the cardiac catheterization laboratory (cathlab).
• Manual aspiration thrombectomy is the only protection device with evidence of efficiency against coronary clot embolism.
• Drug-eluting stents in primary angioplasty should be reserved for high-risk patients and lesions for restenosis (TLR).
• Controlled revascularization strategies are needed to minimize reperfusion injury.
• Radial access is recommended as the preferred initial approach due to a lower rate of hemorrhagic complications.

Impact:

• Improved clinical decision-making in PCI procedures.
• Potential reduction in procedural complications and long-term adverse events.
• Guidance on optimal use of interventional tools and techniques for myocardial reperfusion.