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CLINICIAN'S CORNER
Primary Coronary Intervention for Acute Myocardial Infarction
Ellen C. Keeley, MD;
Cindy L. Grines, MD
JAMA. 2004;291:736-739.
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INTRODUCTION
Despite dramatic improvements in the treatment of acute ST-segment elevation myocardial infarction (STEMI) during the past decade, approximately 1 in 10 patients still die of this disease.1 Three critical factors in the immediate management of patients with STEMI result in reduced mortality: prompt diagnosis, immediate treatment with aspirin, and rapid reestablishment of blood flow in the infarct-related artery. The latter aim may be achieved either pharmacologically, with administration of thrombolytic therapy, or mechanically, with percutaneous coronary intervention (PCI). Primary PCI refers to the strategy of emergent angiography followed by mechanical recanalization of the occluded artery with a balloon catheter, without prior administration of thrombolytic therapy. In its early years, the data regarding primary PCI were limited to observational studies from specialized centers. With the publication of randomized controlled trials (RCTs) comparing PCI with thrombolytic therapy, however, primary PCI has become . . . [Full Text of this Article]
Pathophysiology of STEMI
Strengths of Thrombolytic Therapy and Primary PCI
Randomized Trials Comparing Primary PCI and Thrombolytic Therapy
Technical Aspects of Primary PCI
Primary PCI in Specific Patient Populations
Adjunctive Therapies in Patients Undergoing Primary PCI
Conclusion
Author Affiliations: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (Dr Keeley); Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Mich (Dr Grines).
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