Primary stenting and glycoprotein IIb/IIIa inhibitors in acute myocardial infarction

Early patency of the infarct-related vessel improves in-hospital and long-t erm survival. Mechanical reopening is as effective as or superior to pharma cological therapy in the treatment of acute myocardial infarction. However, in patients treated with primary percutaneous transluminal coronary angiop lasty, recurrent ischemia occurs in 10% to 15% before hospital discharge, a nd angiographic restenosis occurs in 30% to 50% of infarct-related vessel w ithin 6 months. Primary stenting in acute myocardial infarction has been fo und to be safe and feasible and reduces early and late events. In particula r, restenosis rate has been found to be lowered by stent implantation. Use of glycoprotein IIb/IIIa receptor inhibitors alone has resulted in infarct- related vessel potency rates approximately the some as with the use of thro mbolytic therapy. Furthermore, glycoprotein IIb/IIIa receptor blockers redu ce the occurrence of acute complications during percutaneous transluminal c oronary angioplasty. Preliminary results of some ongoing trials showed that the combined therapeutic approach (ie, primary stenting plus glycoprotein IIb/IIIa inhibitors) in patients with acute myocardial infarction reduces b oth early and late complications of percutaneous transluminal coronary angi oplasty. This finding supports the concept that optimal mechanical resoluti on of the plaque and the inhibition of platelet aggregation are the key of the treatment of the infarct-related vessel.