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(Circulation. 2003;108:1292.)
© 2003 American Heart Association, Inc.

Focused Perspective

Percutaneous Coronary Intervention in Stable Patients After Acute Myocardial Infarction

William S. Weintraub, MD; Saihari Sadanandan, MD

From the Departments of Medicine, Emory University, Atlanta, Ga (W.S.W.), and University of Oklahoma, Oklahoma City (S.S.).

Correspondence to William S. Weintraub, MD, Emory University, 1256 Briarcliff Rd, Atlanta, GA 30306. E-mail wweintr@emory.edu

Key Words: Editorials • myocardial infarction • angioplasty • reperfusion

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Reperfusion after acute ST-segment elevation myocardial infarction (AMI) remains the cornerstone of the initial therapy. Although reperfusion can be accomplished with either primary angioplasty or fibrinolytic therapy, clinical trial data reveal improved outcome with primary angioplasty. Furthermore, primary angioplasty with coronary stenting results in less repeat revascularization than balloon angioplasty. Despite the advantages of mechanical revascularization, primarily with stenting, the majority of patients presenting with AMI will receive pharmacological reperfusion.

See p 1324

How then should patients with AMI who are initially treated medically subsequently be managed? Medical therapy with platelet inhibition, ß-blockade, ACE inhibition, and lipid lowering can all be accomplished according to guidelines. However, what is the role of revascularization after the most acute period? In patients with recurrent ischemia or severe multivessel disease with left ventricular dysfunction, the role of revascularization is relatively clear. However, is there a place for routine percutaneous revascularization (percutaneous coronary intervention [PCI]) in stable, post-AMI patients with 1-vessel disease?

To address this question, Zeymer et al¹ randomized 300 patients with 1-vessel disease 1 to 6 weeks after AMI to angioplasty or medical therapy between 1994 and 1997. Fibrinolytic therapy was used in 180 patients (60%). All patients had significant stenosis or total occlusion (29%) of the infarct-related artery (IRA) and no or mild angina. All but 11 (7.4%) patients in the invasive arm underwent angioplasty, but only 17% received stents. One-year mortality was 0.7% with angioplasty versus 3.3% with medical therapy (P=0.21), and freedom from death, MI, revascularization, or readmission . . . [Full Text of this Article]

Related Article:

Randomized Comparison of Percutaneous Transluminal Coronary Angioplasty and Medical Therapy in Stable Survivors of Acute Myocardial Infarction With Single Vessel Disease: A Study of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte

Uwe Zeymer, Rainer Uebis, Albrecht Vogt, Hans-Georg Glunz, Hans-Friedrich Vöhringer, Dietrich Harmjanz, and Karl-Ludwig Neuhaus
Circulation 2003 108: 1324-1328. [Abstract] [Full Text]

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