title: Weaknesses in regional primary coronary angioplasty programs: is there still a role for a pharmaco-invasive approach?
abstract: All guidelines recommend primary percutaneous coronary intervention as the default strategy for achieving reperfusion in ST-segment elevation myocardial infarction patients. These recommendations are based upon randomized trials which compared primary percutaneous coronary intervention with stand-alone intravenous fibrinolysis. Since the time these trials were performed, however, it has been shown in further trials that use of rescue percutaneous coronary intervention in patients without signs of reperfusion after lysis, and routine coronary angiography within 24 h of the administration of lysis for all other patients, substantially improved the results of intravenous fibrinolytic treatment. This has led to proposing the pharmaco-invasive strategy as an alternative to primary percutaneous coronary intervention. Actually, it is not uncommon that circumstances prevent performing primary percutaneous coronary intervention within the recommended time limits set by the guidelines. In such cases, using a pharmaco-invasive strategy may constitute a valid alternative. Both the STREAM randomized trial and real-world experience, in particular the long-term results from the FAST-MI registry, suggest that the pharmaco-invasive strategy, when used in an appropriate population, compares favorably with primary percutaneous coronary intervention. Therefore, implementing a pharmaco-invasive strategy protocol may be an important complement to compensate for potential weaknesses in ST-segment elevation myocardial infarction networks.
authors.affiliation: Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and Faculté de Médecine, Université Paris-Descartes, Paris, France. Electronic address: danchin.hegp@yahoo.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and Faculté de Médecine, Université Paris-Descartes, Paris, France.
authors.forename: Nelson
authors.initials: N
authors.lastname: Dos Santos Teixeira
authors.affiliation: Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and Faculté de Médecine, Université Paris-Descartes, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000592:standards*; D017023:Coronary Angiography; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D017410:Practice Guidelines as Topic; D012042:Registries; D015912:Thrombolytic Therapy / Q000592:standards*
chemical_list: D005343:Fibrinolytic Agents
keywords: Estrategia farmacoinvasiva; Fibrinolisis; Fibrinolysis; Infarto agudo de miocardio con elevación del segmento ST; Intervención coronaria percutánea primaria; Pharmaco-invasive strategy; Primary percutaneous coronary intervention; ST-segment elevation myocardial infarction