Percutaneous coronary intervention and beyond for ST-elevation acute myocardial infarction

The short- and long-term prognosis of acute myocardial infarction (MI) has markedly improved over the past 20 years, from 19% in 1986 to the current 5-6%. One of the reasons for this decrease is the introduction of more effective myocardial reperfusion techniques, as it has been clearly demonstrated that the rapidity, extent, and durability of reperfusion are an important prognostic determinant. Primary percutaneous coronary intervention has been shown to be superior to fibrinolytic treatment because it leads to a higher reperfusion rate. Myocardial salvage after the timely revascularization of an infarct-related artery critically depends on coronary blood flow to the area at risk, and therefore the adequacy of arterial reperfusion in acute MI depends not only on the persistent arterial patency, but also on the integrity of the distal circulation. At the microcirculatory level, distal embolization from the lesion site, the release of vasoconstrictive platelet mediators, and vascular reperfusion injury due to cardiac inflammatory responses may all compromise recovery, and therefore efficacious treatment of acute MI requires the restoration of patent epicardial flow and the preservation of microvascular integrity. The various techniques currently being evaluated for their ability to reduce final infarct size will be discussed.