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A. Michael Lincoff, MD

JAMA. 2004;291:1000-1002.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Notwithstanding efficacy demonstrated in randomized trials, reperfusion strategies for acute myocardial infarction (MI) remain subject to considerable limitations. A plateau of mortality reduction seemingly has been reached with fibrinolytic therapy,¹ a lack of progress that may relate to the apparent "ceiling" of coronary patency achieved with these drugs, reocclusion, or impaired microvascular tissue level reperfusion. Moreover, the catastrophic complication of intracranial hemorrhage continues to occur in up to 1% of patients receiving fibrinolytic agents.¹ Mechanical approaches to revascularization with balloon angioplasty or coronary stenting overcome some limitations of pharmacologic reperfusion, as randomized trials comparing fibrinolysis with primary percutaneous coronary intervention (PCI) in general have shown the latter to be associated with lower rates of death or reinfarction and markedly diminished hemorrhagic complications.²

Difficulties also exist with primary PCI, however, including limited availability and delays in mobilizing catheterization laboratory teams. These logistical barriers may substantially prolong the . . . [Full Text of this Article]

Author Affiliation: Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.

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