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(Circulation. 2008;118:538-551.)
© 2008 American Heart Association, Inc.

Advances in Interventional Cardiology

Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

Part I: Primary Percutaneous Coronary Intervention

Gregg W. Stone, MD

From Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY.

Correspondence to Gregg W. Stone, MD, Columbia University Medical Center, 111 E 59th St, 11th Floor, New York, NY 10022. E-mail gs2184@columbia.edu

Key Words: angioplasty • myocardial infarction • stents • thrombolysis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Cardiovascular disease is the most common cause of mortality in most developed nations; 838 000 in-hospital discharges in the United States in 2005 were for acute myocardial infarction, 29% to 47% of which were acute ST-segment-elevation myocardial infarction (STEMI).¹ The case fatality rate of STEMI has fallen dramatically in the last 3 decades, in part because of the widespread use of reperfusion therapy.^1–4 STEMI is in most cases due to rupture of an inflamed thin-capped fibroatheroma containing a lipid-rich necrotic core with superimposed secondary thrombosis resulting in coronary artery occlusion.^5,6 From the seminal demonstration by Reimer et al⁷ that canine coronary occlusion results in a several-hour wave front of necrosis spreading from the subendocardial to the subepicardial myocardium arose the hypothesis that timely restoration of flow in the occluded coronary artery would salvage jeopardized myocardium and enhance survival. Effective reperfusion in STEMI can be achieved by either fibrinolytic therapy or primary percutaneous coronary intervention (PCI) without antecedent fibrinolysis (also generally known as primary angioplasty). Fibrinolysis and PCI also may be combined in a variety of ways, depending on the timing of PCI after fibrinolytic administration, the clinical condition of the patient, and whether PCI is applied routinely or selectively after lytic therapy. Randomized trials have collectively demonstrated enhanced survival and freedom from major adverse cardiovascular events with primary PCI compared with fibrinolysis, and as a result, the expeditious performance of primary PCI has become the preferred reperfusion modality for patients with STEMI presenting at appropriately equipped centers.

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