Primary PCI in ST-elevation myocardial infarction
This chapter specifically focuses on the role of the cardiac catheterization laboratory in stent thrombosis elevation myocardial infarction (STEMI). A comprehensive knowledge of STEMI and percutaneous coronary intervention (PCI) guidelines, as well as an understanding of the reperfusion strategies, adjunctive treatments, and the local health care system competencies and constraints is required to optimally manage these potentially complex patients. In patients with STEMI, reperfusion choices include primary PCI, fibrinolytic therapy, and acute surgical revascularization. Patients with STEMI complicated by cardiogenic shock are a subgroup benefiting from preferential referral for emergency primary PCI. With a facilitated PCI strategy, STEMI patients are administered a fibrinolytic agent as an intentional adjunctive treatment to emergency primary PCI. During primary PCI, implantation of a drug-eluting stent (DES) is preferred over a bare-metal stent (BMS), given the lower rates of restenosis and target lesion revascularization (TLR) associated with DES.
