ST elevation myocardial infarction primary percutaneous coronary intervention
| Myocardial infarction | |
 | |
|---|---|
| Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA). | |
| ICD-10 | I21-I22 |
| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
| eMedicine | med/1567 emerg/327 ped/2520 |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Vijayalakshmi Kunadian MBBS MD MRCP [2]
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Definitions
Primary PCI
Primary PCI is defined as the performance of percutaneous coronary intervention (PCI) (either conventional balloon angioplasty or coronary stent placement) in the setting of ST elevation MI (STEMI) without antecedent treatment with a fibrinolytic agent. The chapter on Primary PCI can be found here. Primary PCI is the subject of this chapter.
Facilitated PCI
Facilitated PCI is defined as the intent to perform a PCI (either conventional balloon angioplasty or coronary stent placement) in the setting of STEMI following treatment with either a full dose or half dose of a fibrinolytic agent. This approach is also termed a pharmaco-invasive strategy. This strategy differs from rescue or adjunctive PCI in that the intent of facilitated PCI is to perform PCI, and the administration of a fibrinolytic agent is intended to improve the PCI results. The chapter on Facilitated PCI can be found here.
Rescue PCI
Rescue PCI is defined as the intent to administer a fibrinolytic agent in the setting of STEMI, and the performance of PCI for failure of the fibrinolytic agents is unintended. If there are clinical signs and symptoms of failure of the fibrinolytic agent to achieve reperfusion, then rescue PCI is performed to open the totally occluded artery. The strategy differs from facilitated PCI in that the intent is to administer a fibrinolytic agent, and the performance of PCI is intended to improve the fibrinolytic results. The chapter on Rescue PCI can be found here.
Adjunctive PCI
Adjunctive PCI is defined as the intent to administer fibrinolytic agent in the setting of STEMI, and the performance of PCI for partial success of the fibrinolytic agent is unintended. If there are clinical signs and symptoms of incomplete reperfusion, then adjunctive PCI is performed to further open a patent artery (one with TIMI grade 2 or 3 flow). The strategy differs from facilitated PCI in that the intent is to administer a fibrinolytic agent, and the performance of PCI is intended to improve the fibrinolytic results.
Primary Percutaneous coronary intervention
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Abbreviations and acronyms
ADMIRAL Abciximab before Direct Angioplasty and Stenting in Myocardial Infarction Regarding Acute and Long-term follow-up
ASPV Average systolic peak velocity
C-PORT Cardiovascular Patients Outcomes Research Team
DANAMI Danish Multicenter Randomized study on fibrinolytic therapy versus Acute Coronary Angioplasty in Acute Myocardial Infarction
DSE Dobutamine stress echocardiography
EMERALD Enhanced Myocardial Efficacy and Recovery by Aspiration of Liberated Debris
FTT Fibrinolysis Therapy Trialists
GUSTO Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes
IC Intracoronary
ICH Intracranial hemorrhage
LVEF Left ventricular ejection fraction
MBG Myocardial blush grade
MCE Myocardial contrast echocardiography
NRMI National Registry of Myocardial Infarction
OAT Occluded artery trial
PAMI Primary angioplasty in Acute Myocardial Infarction
PASSION Paclitaxel-Eluting Stent versus Conventional Stent in Myocardial Infarction with ST-Segment Elevation
PRAGUE PRimary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency fibrinolysis
PTCA Percutaneous transluminal coronary angioplasty
PCI Percutaneous coronary intervention
PPCI Primary percutaneous coronary intervention
RAPPORT Reopro And Primary PTCA Organization and Randomized Trial
RIKS-HIA Register of Information and Knowledge about Swedish Heart Intensive care Admissions
SESAMI Sirolimus-Eluting Stent Versus Bare-Metal Stent in Acute Myocardial Infarction
SK Streptokinase
STRATEGY Single High Dose Bolus Tirofiban and Sirolimus Eluting Stent vs. Abciximab and Bare Metal Stent in Myocardial Infarction study
STEMI ST elevation myocardial infarction
STOP-AMI Stent versus Fibrinolysis for Occluded coronary arteries in patients with Acute Myocardial Infarction
TAPAS Thrombus Aspiration in Percutaneous coronary intervention following Acute myocardial infarction Study.
TFG TIMI flow grade
TIMI Thrombolysis in Myocardial Infarction
TMPG TIMI myocardial perfusion grade
TPA Tissue plasminogen activator
TVR Target vessel revascularization
References