Primary and rescue PCI in acute myocardial infarction and elements of myocardial conditioning

Acute myocardial infarction results when abrupt thrombotic occlusion of a major epicardial coronary occurs. The very early experience led by Hartzler and others indicated that percutaneous coronary intervention (PCI) was not only feasible in acute myocardial infarction, but the recanalization rate was very high, typically exceeding 90%. When compared with fibrinolytic therapy, primary PCI is more efficacious in patients presenting later in the course of myocardial infarction. Radial access in primary PCI is an attractive technique when it can be performed without compromising reperfusion times. Major vascular complications and bleeding can be reduced and there are now strong suggestions of reduced mortality. Pharmacologic therapy in primary PCI has evolved along with advances in supportive therapy for PCI in general, designed to enhance coronary patency, tissue level perfusion, and procedural safety. The ability to limit myocardial damage from prolonged ischemia in acute myocardial infarction has remained unproven.