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Primary Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction

  • Lene Holmvang
  • Francis R. Joshi
Chapter

Abstract

Primary percutaneous coronary intervention (PPCI) is a swift and effective method to ensure reperfusion of the occluded coronary artery in patients with STEMI. Compared with systemic fibrinolysis, the obvious advantage is the avoidance of side effects related to fibrinolytic therapy such as bleeding, but rapid clinical assessment (including urgent bedside echocardiography) and diagnostic coronary angiography are also advantageous in the 15–20% of field-triaged patients with diagnoses other than STEMI. The initial trials documenting a mortality benefit from PPCI compared with fibrinolysis were performed prior to the era of prehospital diagnosis of STEMI. Time from symptom onset to reperfusion (either fibrinolysis or PPCI) is important with regard to mortality and morbidity; healthcare systems have thus evolved to provide the earliest possible initiation of reperfusion therapy. When initiated as part of coordinated systems, it is accepted that PPCI is superior to fibrinolysis. However, some patients are not offered reperfusion by PPCI either because of long transportation times, a lack of suitable PPCI centers, or because the healthcare system has failed to establish a successful prehospital diagnostic program with field triage of patients directly to PCI centers. Previous focus on door-to-balloon (DTB) times has been important to further streamline in-hospital care, but before the patient even reaches the hospital several factors should be in focus in order to reduce delays. Door-to-balloon time alone is a poor parameter to evaluate the efficacy of a healthcare system offering PPCI.

Keywords

ST-elevation myocardial infarction Primary percutaneous coronary intervention Aspiration thrombectomy Door-to-balloon time Left bundle branch block Cardiogenic shock Embolic protection device 

Abbreviations

ACT

Activated clotting time

AHA

American Heart Association

CT

Computed tomography

ESC

European Society of Cardiology

FFR

Fractional flow reserve

LAD

Left anterior descending coronary artery

LCX

Left circumflex artery

PET

Positron emission tomography

PPCI

Primary percutaneous coronary intervention

RCA

Right coronary artery

RCT

Randomized controlled trial

STEMI

ST-elevation myocardial infarction

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Lene Holmvang
    • 1
  • Francis R. Joshi
    • 1
  1. 1.The Heart CenterRigshospitaletCopenhagenDenmark

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