Reperfusion in Acute Myocardial Infarction: How is the Future Shaping up?

Abstract

Current evidence from several clinical trials indicates that primary angioplasty in patients with acute myocardial infarction (AMI) appears superior reperfusion therapy to immediate thrombolysis, even when transfer to an angioplasty center is necessary. Thus, organization of ambulance systems and adequate angioplasty facilities appears to be the key issue in providing the most effective contemporary reperfusion therapy for AMI. Furthermore, on-site primary coronary angioplasty in high-risk AMI patients at hospitals with no cardiac surgery on-site is nowdays considered safe, effective, and faster than angioplasty after transfer to a surgical facility.

   Randomized trials have demonstrated the superiority of primary angioplasty with stent implantation over balloon angioplasty alone in the treatment of AMI, including patients with diabetes. Stent use has been associated with significant decreases in length of stay, major adverse cardiovascular events, and in-hospital mortality. Finally, because of the risk of stent thrombosis, the issue of whether drug-eluting stents are safe or even more beneficial than bare-metal stents in patients with AMI, as in other non-AMI patient groups, remains uncertain, although preliminary data seem to favour the use of drug-eluting stents.