Facilitated percutaneous coronary intervention: Is this strategy ready for implementation?

Derek P. Chew, Phil Aylward, Harvey D. White

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Reperfusion therapy with pharmacologic fibrinolysis has provided striking reductions in mortality following acute ST-elevation myocardial infarction (STEMI). Nevertheless, the limitations of fibrinolysis are well recognized. Attempts to improve reperfusion with bolus-only fibrinolysis, and combination regimens including enoxaparin and glycoprotein IIb/IIIa inhibition have not led to improvements in mortality. Although both prehospital fibrinolysis and primary percutaneous coronary Intervention (PCI) have reduced mortality, these strategies are associated with considerable logistic constraints, hampering widespread implementation. Potentially, a hybrid strategy combining the speed and simplicity of pharmacologic reperfusion with the ability to ensure epicardial vessel patency, and providing definitive management of the culprit lesion remains an attractive option. Facilitated PCI for STEMI may extend the benefit of myocardial reperfusion to a greater number of patients. The true benefit of this strategy will be defined by ongoing large-scale clinical trials. If results are positive, the clinical practice determinants required for the effective application of this strategy to the wider clinical community will need careful consideration.

LanguageEnglish
Pages235-241
Number of pages7
JournalCurrent Cardiology Reports
Volume7
Issue number4
DOIs
Publication statusPublished - 1 Jan 2005

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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abstract = "Reperfusion therapy with pharmacologic fibrinolysis has provided striking reductions in mortality following acute ST-elevation myocardial infarction (STEMI). Nevertheless, the limitations of fibrinolysis are well recognized. Attempts to improve reperfusion with bolus-only fibrinolysis, and combination regimens including enoxaparin and glycoprotein IIb/IIIa inhibition have not led to improvements in mortality. Although both prehospital fibrinolysis and primary percutaneous coronary Intervention (PCI) have reduced mortality, these strategies are associated with considerable logistic constraints, hampering widespread implementation. Potentially, a hybrid strategy combining the speed and simplicity of pharmacologic reperfusion with the ability to ensure epicardial vessel patency, and providing definitive management of the culprit lesion remains an attractive option. Facilitated PCI for STEMI may extend the benefit of myocardial reperfusion to a greater number of patients. The true benefit of this strategy will be defined by ongoing large-scale clinical trials. If results are positive, the clinical practice determinants required for the effective application of this strategy to the wider clinical community will need careful consideration.",
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Facilitated percutaneous coronary intervention : Is this strategy ready for implementation? / Chew, Derek P.; Aylward, Phil; White, Harvey D.

In: Current Cardiology Reports, Vol. 7, No. 4, 01.01.2005, p. 235-241.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Facilitated percutaneous coronary intervention

T2 - Current Cardiology Reports

AU - Chew, Derek P.

AU - Aylward, Phil

AU - White, Harvey D.

PY - 2005/1/1

Y1 - 2005/1/1

N2 - Reperfusion therapy with pharmacologic fibrinolysis has provided striking reductions in mortality following acute ST-elevation myocardial infarction (STEMI). Nevertheless, the limitations of fibrinolysis are well recognized. Attempts to improve reperfusion with bolus-only fibrinolysis, and combination regimens including enoxaparin and glycoprotein IIb/IIIa inhibition have not led to improvements in mortality. Although both prehospital fibrinolysis and primary percutaneous coronary Intervention (PCI) have reduced mortality, these strategies are associated with considerable logistic constraints, hampering widespread implementation. Potentially, a hybrid strategy combining the speed and simplicity of pharmacologic reperfusion with the ability to ensure epicardial vessel patency, and providing definitive management of the culprit lesion remains an attractive option. Facilitated PCI for STEMI may extend the benefit of myocardial reperfusion to a greater number of patients. The true benefit of this strategy will be defined by ongoing large-scale clinical trials. If results are positive, the clinical practice determinants required for the effective application of this strategy to the wider clinical community will need careful consideration.

AB - Reperfusion therapy with pharmacologic fibrinolysis has provided striking reductions in mortality following acute ST-elevation myocardial infarction (STEMI). Nevertheless, the limitations of fibrinolysis are well recognized. Attempts to improve reperfusion with bolus-only fibrinolysis, and combination regimens including enoxaparin and glycoprotein IIb/IIIa inhibition have not led to improvements in mortality. Although both prehospital fibrinolysis and primary percutaneous coronary Intervention (PCI) have reduced mortality, these strategies are associated with considerable logistic constraints, hampering widespread implementation. Potentially, a hybrid strategy combining the speed and simplicity of pharmacologic reperfusion with the ability to ensure epicardial vessel patency, and providing definitive management of the culprit lesion remains an attractive option. Facilitated PCI for STEMI may extend the benefit of myocardial reperfusion to a greater number of patients. The true benefit of this strategy will be defined by ongoing large-scale clinical trials. If results are positive, the clinical practice determinants required for the effective application of this strategy to the wider clinical community will need careful consideration.

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