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(Circulation. 2008;118:552-566.)
© 2008 American Heart Association, Inc.

Advances in Interventional Cardiology

Angioplasty Strategies in ST-Segment–Elevation Myocardial Infarction

Part II: Intervention After Fibrinolytic Therapy, Integrated Treatment Recommendations, and Future Directions

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

 
As reviewed in part I of this report,¹ primary PCI without antecedent fibrinolytic therapy has become widely accepted as the preferred reperfusion modality for patients with ST-segment–elevation myocardial infarction (STEMI) presenting at suitably equipped tertiary facilities. However, primary percutaneous coronary intervention (PCI) is not offered at 50% of US hospitals, and many of those that do are unable to offer primary PCI as an around-the-clock service. Primary PCI also is less widely available in many other countries than in the United States. Thus, fibrinolytic therapy continues to be administered to many patients with STEMI.^2,3 Given the relatively low rates of successful reperfusion with fibrinolysis,^4,5 revascularization often is required afterward, the indications for and outcomes of which are critically evaluated here. The impact of individual operator and institutional volumes on PCI outcomes is reviewed. Evidence-based recommendations for selecting among the various reperfusion therapy options are then offered for the patients with STEMI presenting at centers with and without interventional capabilities, with distinctions drawn where the evidence-based recommendations in this article differ substantially from recently updated task force guidelines of the American College of Cardiology (ACC) and American Heart Association (AHA).⁵ Finally, recent and ongoing investigations to further improve outcomes after catheter-based reperfusion therapy are summarized.

	Angioplasty After Fibrinolytic Therapy

 
PCI after fibrinolytic therapy in STEMI may be performed in a variety of settings: (1) rescue PCI after failed fibrinolysis in patients with ongoing symptoms, myocardial injury, or persistent coronary occlusion, typically initiated within 60 to 120 minutes after fibrinolytic administration; (2) immediate PCI (also known . . . [Full Text of this Article]

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