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STATE-OF-THE-ART PAPER

Facilitated Percutaneous Coronary Intervention

Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.

Manuscript received March 24, 2006; accepted March 30, 2006.

^_* Reprint requests and correspondence: Dr. David P. Faxon, Department of Medicine, Brigham and Women’s Hospital, Department of Medicine, 1620 Tremont Street, OBC-3-12P, Boston, Massachusetts 02120. (Email: dfaxon{at}partners.org).

The goal of the initial treatment for ST-segment elevation myocardial infarction is rapid and effective reperfusion. Randomized trials have demonstrated that primary angioplasty is preferred over thrombolysis if done in a timely manner and by an experienced team. However, due to many factors, performance of primary angioplasty within the goal of 90 min is often not possible. A combined strategy of immediate thrombolysis in the emergency room or in the ambulance followed by angioplasty theoretically could provide early reperfusion with subsequent angioplasty to insure complete reperfusion. Over 17 clinical trials have been reported. Compared with thrombolysis, facilitated angioplasty in the most recent trials has been shown to have a more favorable long-term outcome. Trials comparing facilitated angioplasty with full- or half-dose thrombolysis versus primary angioplasty have been far less favorable with the largest trial to date, the ASSENT (Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention)-4 trial, demonstrating a worse outcome in the primary end point of death, congestive heart failure, or shock at 90 days. Pending the results of the FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) trial, current data suggest that facilitated angioplasty does not offer any advantage over primary angioplasty and may be harmful.

Abbreviations and Acronyms   AHA/ACC = American Heart Association/American College of Cardiology   AMI = acute myocardial infarction   ECSG = European Cooperative Study Group   PCI = percutaneous coronary intervention   PTCA = percutaneous transluminal coronary angioplasty   STEMI = ST-segment elevation acute myocardial infarction   TNK = tenecteplase   t-PA = tissue plasminogen activator

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