Interventional procedures in acute myocardial infarction

Background Acute myocardial infarction (MI) remains a leading cause of deat h in the United States. There is evidence that primary (direct) percutaneou s intervention (PCI) may improve survival and reduce morbidity in patients with acute MI. Methods We present a concise, comprehensive, evidence-based literature revi ew of modern techniques of primary PCI in patients with acute MI. A compari son to thrombolytic therapy, especially in selected patient subgroups is ma de. Rescue angioplasty is also addressed. Adjunctive pharmacology, economic implications, and feasibility of implementation are discussed. A brief dis cussion of experimental therapies is included. Results Primary PCI is an acceptable alternative to thrombolytic therapy in patients with acute MI and may result in superior outcomes in select patie nt populations, especially the elderly, patients with prior coronary artery bypass surgery, those with congestive heart failure, and those in cardioge nic shock. Conclusions Clinical trials support the use of primary PCI as first-line th erapy for acute myocardial infarction. Patients in whom thrombolytic therap y is contraindicated or known to have reduced efficacy are also excellent c andidates for this therapy. Ongoing advancements in equipment and adjunctiv e therapies continue to enhance delivery of this treatment as well as impro ve patient outcome.