Facilitated primary percutaneous coronary intervention - the current view

The treatment of acute ST segment elevation myocardial infarction (STEMI) passed through important development concentrated on prognostic impact of the patients during last 20 years. Primary percutaneous coronary intervention (pPCI) became the method of the choice in this situation. Nowadays the possibility how to combine the advantage of immediately accessible fibrinolytic therapy and PCI provided immediately after transportation of the patient to the PCI centre is searched for. This approach is named facilitated PCI. The principal idea is that as earlier the flow in the infarct related artery is restored, as better prognosis of the patients. As well implantation of the stent into the infarct related artery even if the flow after fibrinolytic therapy is good improves the prognosis of the patients. This is why they are trying to combine the early PCI with fibrinolytic application or treatment by glycoprotein IIb/IIIa receptor antagonists or combination of both before the transport to the PCI centre. The results of smaller studies or of those, which were not primary orientated on this problem seem to be promising, but before the definitive decision if, when and to whom to indicate facilitation and by which pharmacological agent we must wait for the results of large randomised studies, of which the primary aim is the facilitation of PCI.

Keywords: Key words: acute coronary syndrome, direct percutaneous coronary intervention, fibrinolytic treatment.