Triple therapy for acute myocardial infarction: Combining fibrinolysis, platelet IIb/IIIa inhibition, and percutaneous coronary intervention

Reperfusion for acute myocardial infarction (MI) has generally been approac hed in 1 of 2 ways-fibrinolysis or primary angioplasty, Although fibrinolys is is widely available and has been shown to reduce mortality and improve l eft ventricular function, its disadvantages include hemorrhage, failure to reperfuse in vp to 40% of patients, and early reocclusion in up to 10% of p atients. Alternatively, primary angioplasty offers the advantages of anatom ic definition, the potential for higher rates of reperfusion, and a lower r ate of intracranial hemorrhage, Recently, a better understanding of platele t physiology and its inhibition, and advances in mechanical revascularizati on with stents have led to combined approaches (fibrinolytic agents, glycop rotein IIb/IIIa inhibitors, and percutaneous coronary interventions [PCI]), Faciliated PCI, the use of planned PCI after pharmacologic reperfusion the rapy, has the best potential to fuse the best aspects of thrombolysis and p rimary angioplasty, This article reviews recent advances and trials studyin g use of these combinations, (C) 2000 by Excerpta Medico, Inc.