Facilitated PCI

Immediate percutaneous coronary intervention (PCI) is the treatment of choice for acute ST-segment elevation myocardial infarction. In this study, PCI that was “facilitated” by pretreatment with reteplase plus abciximab or abciximab alone did not improve clinical outcomes and actually increased bleeding as compared to primary PCI alone. The primary end point was the composite of death from all causes, ventricular fibrillation occurring more than 48 hours after randomization, cardiogenic shock, and congestive heart failure during the first 90 days after randomization. There was no difference in the primary end point between the three groups.

“ . . . the use of facilitated pharmacologic strategy for reperfusion, with either abciximab alone or abciximab plus reduced-dose reteplase, in anticipation of urgent PCI for patients with an ST-segment elevation myocardial infarction cannot be justified by the results of this trial.”

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New England Journal of Medicine - Vol. 358, No. 21