Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List    Related articles in Annals  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Keeley, E. C.    Grines, C. L.    Related Articles in PubMed    PubMed Citation    PubMed

IN THE BALANCE

Primary Percutaneous Coronary Intervention for Every Patient with ST-Segment Elevation Myocardial Infarction: What Stands in the Way?

Ellen C. Keeley, MD, and Cindy L. Grines, MD

17 August 2004 | Volume 141 Issue 4 | Pages 298-304

According to data from randomized, controlled trials, primary percutaneous coronary intervention (PCI) is the treatment of choice for ST-segment elevation myocardial infarction (MI). In these trials, 1 life was saved and 2 other life-threatening complications, including stroke and reinfarction, were prevented for every 50 patients with ST-segment elevation MI treated with primary PCI rather than thrombolytic therapy. Only 1 major bleeding episode occurred.

How can these superior results be realized outside the context of randomized trials? We anticipate 4 obstacles to instituting primary PCI as the universal treatment of ST-segment elevation MI: 1) lack of timely availability, 2) technical expertise of center and operator, 3) the need to address patient subgroups that are not studied in randomized trials, and 4) comparisons of primary PCI to newer pharmacologic regimens.

We propose 3 strategies to increase the availability of this procedure: 1) perform primary PCI in qualified community hospitals without surgical back-up; 2) transfer patients from community hospitals without primary PCI capability to hospitals with primary PCI capability; and 3) develop a universal system in which ambulances directly transfer patients to a regional primary PCI center, not necessarily to the closest hospital, similar to the system used for trauma patients. We contend that, in light of the superior clinical outcomes seen with primary PCI for treating ST-segment elevation MI, this procedure should be available to all patients with ST-segment elevation MI and efforts should be made to institute these measures.

Author and Article Information

From the University of Texas Southwestern Medical Center, Dallas, Texas; and William Beaumont Hospital, Royal Oak, Michigan.

Potential Financial Conflicts of Interest:Consultancies: C.L. Grines (Aventis, Guidant, Pfizer, Innercool Therapies, The Medicines Company); Grants received: C.L. Grines (Berlex, GlaxoSmithKline, Pfizer, Guidant, Eli Lilly and Company, SCIMED, Johnson & Johnson, Aventis, Amersham Health, Otsuka, Esperion Therapeutics, Innercool Therapies).

Requests for Single Reprints: Ellen C. Keeley, MD, Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8837; e-mail, ellen.keeley{at}utsouthwestern.edu.

Current Author Addresses: Dr. Keeley: Division of Cardiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8837.

Dr. Grines: William Beaumont Hospital, 3601 West Thirteen Mile Road, Royal Oak, MI 48073-6769.

Related articles in Annals:

In the Balance
Primary Angioplasty and Thrombolysis Are Both Reasonable Options in Acute Myocardial Infarction
James M. Brophy AND Peter Bogaty

Annals 2004 141: 292-297. [ABSTRACT][Full Text]  

This article has been cited by other articles:

				G. Ellrodt, L. B. Sadwin, T. Aversano, B. Brodie, P. K. O'Brien, R. Gray, L. F. Hiratzka, and D. Larson Development of Systems of Care for ST-Elevation Myocardial Infarction Patients: The Non-Percutaneous Coronary Intervention-Capable (ST-Elevation Myocardial Infarction Referral) Hospital Perspective Circulation, July 10, 2007; 116(2): e49 - e54. [Full Text] [PDF]

				I. Popescu, M. S. Vaughan-Sarrazin, and G. E. Rosenthal Differences in Mortality and Use of Revascularization in Black and White Patients With Acute MI Admitted to Hospitals With and Without Revascularization Services JAMA, June 13, 2007; 297(22): 2489 - 2495. [Abstract] [Full Text] [PDF]

				R Marcucci, D Brogi, F Sofi, C Giglioli, S Valente, A Alessandrello Liotta, M Lenti, A M Gori, D Prisco, R Abbate, et al. PAI-1 and homocysteine, but not lipoprotein (a) and thrombophilic polymorphisms, are independently associated with the occurrence of major adverse cardiac events after successful coronary stenting Heart, March 1, 2006; 92(3): 377 - 381. [Abstract] [Full Text] [PDF]

				T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]

				S. R. Steinhubl, R. Charnigo, and D. J. Moliterno Resistance to Antiplatelet Resistance: Is it Justified? J. Am. Coll. Cardiol., June 7, 2005; 45(11): 1757 - 1758. [Full Text] [PDF]

				T. A. Stukel, F. L. Lucas, and D. E. Wennberg Long-term Outcomes of Regional Variations in Intensity of Invasive vs Medical Management of Medicare Patients With Acute Myocardial Infarction JAMA, March 16, 2005; 293(11): 1329 - 1337. [Abstract] [Full Text] [PDF]

				S. S. Rathore, A. J. Epstein, K. G. M. Volpp, and H. M. Krumholz Regionalization of Care for Acute Coronary Syndromes: More Evidence Is Needed JAMA, March 16, 2005; 293(11): 1383 - 1387. [Full Text] [PDF]

				E. Mahmud, B. Pezeshki, A. Salami, and S. Keramati Highlights of the 2004 Transcatheter Cardiovascular Therapeutics (TCT) annual meeting: Clinical implications J. Am. Coll. Cardiol., March 1, 2005; 45(5): 796 - 801. [Full Text] [PDF]