title: What is the optimum adjunctive reperfusion strategy for primary percutaneous coronary intervention?
abstract: Acute ST-segment elevation myocardial infarction (STEMI) is a dynamic, thrombus-driven event. As understanding of its pathophysiology has improved, the central role of platelets in initiation and orchestration of this process has become clear. Key components of STEMI include formation of occlusive thrombus, mediation and ultimately amplification of the local vascular inflammatory response resulting in increased vasoreactivity, oedema formation, and microvascular obstruction. Activation, degranulation, and aggregation of platelets are the platforms from which these components develop. Therefore, prompt, potent, and predictable antithrombotic therapy is needed to optimise clinical outcomes after primary percutaneous coronary intervention. We review present pharmacological and mechanical adjunctive therapies for reperfusion and ask what is the optimum combination when primary percutaneous coronary intervention is used as the mode of revascularisation in patients with STEMI.
authors: Wessex Cardiothoracic Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK. nick.curzen@uhs.nhs.uk
authors: Nicholas
authors: N
authors: Curzen
authors: Paul A
authors: PA
authors: Gurbel
authors: Aung
authors: A
authors: Myat
authors: Deepak L
authors: DL
authors: Bhatt
authors: Simon R
authors: SR
authors: Redwood
mesh_terms: D000249:Adenosine Monophosphate / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D000284:Administration, Oral; D000925:Anticoagulants / Q000627:therapeutic use; D003131:Combined Modality Therapy; D006801:Humans; D007263:Infusions, Parenteral; D039661:Integrin beta3 / Q000187:drug effects; D009203:Myocardial Infarction / Q000188:drug therapy / Q000601:surgery*; D015425:Myocardial Reperfusion; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D040201:Platelet Membrane Glycoprotein IIb / Q000187:drug effects; D015912:Thrombolytic Therapy
chemical_list: D000925:Anticoagulants; D039661:Integrin beta3; D010975:Platelet Aggregation Inhibitors; D040201:Platelet Membrane Glycoprotein IIb; D000249:Adenosine Monophosphate; C117446:cangrelor