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European Heart Journal Advance Access originally published online on June 15, 2007
European Heart Journal 2007 28(13):1545-1553; doi:10.1093/eurheartj/ehm222
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Facilitated percutaneous coronary intervention: current concepts, promises, and pitfalls

Thomas J. Kiernan, Henry H. Ting and Bernard J. Gersh*

Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA

Received 22 September 2006; revised 20 March 2007; accepted 3 May 2007; online publish-ahead-of-print 15 June 2007.

* Corresponding author. Tel: +1 507 284 4139; fax: +1 507 266 0229. E-mail address: gersh.bernard{at}mayo.edu

The reperfusion era has dramatically and irrevocably transformed the management of ST-segment elevation myocardial infarction (STEMI). For the patient treated with fibrinolysis as the initial reperfusion strategy, subsequent options which are the subject of some controversy and the focus of this review are (i) facilitated percutaneous coronary intervention (PCI); (ii) pharmacoinvasive approach; (iii) ‘Watchful waiting’. We performed a literature search of all available articles on facilitated PCI published in English language on Medline, including randomized controlled trials, meta-analyses, and review articles. This information provided the core for a critical appraisal of the current literature on this controversial topic. On the basis of current available data, facilitated PCI with a thrombolytic agent has no role in everyday clinical practice and facilitated PCI utilizing a glycoprotein IIbIIIa inhibitor agent has no considerable benefit on mortality in STEMI in contemporary practice. The evidence to date suggests that fibrinolytic-facilitated PCI is associated with higher mortality rates and adverse events compared with primary PCI.

Key Words: Facilitated percutaneous coronary intervention • ST-elevation myocardial infarction


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