ST elevation myocardial infarction adjunctive percutaneous coronary intervention
| Myocardial infarction | |
| ICD-10 | I21-I22 |
|---|---|
| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
| eMedicine | med/1567 emerg/327 ped/2520 |
| Cardiology Network |
 Discuss ST elevation myocardial infarction adjunctive percutaneous coronary intervention further in the WikiDoc Cardiology Network |
| Adult Congenital |
|---|
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| Congestive Heart Failure |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Vijayalakshmi Kunadian MBBS MD MRCP [2]
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Adjunctive PCI
Adjunctive PCI is defined as the intent to administer fibrinolytic agent in the setting of STEMI, and the performance of PCI for partial success of the fibrinolytic agent is unintended. If there are clinical signs and symptoms of incomplete reperfusion, then adjunctive PCI is performed to further open a patent artery (one with TIMI grade 2 or 3 flow). The strategy differs from facilitated PCI, a strategy in which the intent is to administer a fibrinolytic agent, and the performance of PCI is intended to improve the fibrinolytic results.
Strategies the Adjunctive PCI should be distinguished from:
Primary PCI
Primary PCI is defined as the performance of percutaneous coronary intervention (PCI) (either conventional balloon angioplasty or coronary stent placement) in the setting of ST elevation MI (STEMI) without antecedent treatment with a fibrinolytic agent. The chapter on Primary PCI can be found here.
Facilitated PCI
Facilitated PCI is defined as the intent to perform a PCI (either conventional balloon angioplasty or coronary stent placement) in the setting of STEMI following treatment with either a full dose or half dose of a fibrinolytic agent. This approach is also termed a pharmaco-invasive strategy. This strategy differs from rescue or adjunctive PCI in that the intent of facilitated PCI is to perform PCI, and the administration of a fibrinolytic agent is intended to improve the PCI results. The chapter on Facilitated PCI can be found here.
Rescue PCI
Rescue PCI is defined as the intent to administer a fibrinolytic agent in the setting of STEMI, and the performance of PCI for failure of the fibrinolytic agents is unintended. If there are clinical signs and symptoms of failure of the fibrinolytic agent to achieve reperfusion, then rescue PCI is performed to open the totally occluded artery. The strategy differs from facilitated PCI in that the intent is to administer a fibrinolytic agent, and the performance of PCI is intended to improve the fibrinolytic results. The chapter on Rescue PCI can be found here.
Adjunctive PCI
Data to support performance of adjunctive PCI on an open artery following fibrinolytic administration is sparse. Non randomized data from the TIMI studies published by Gibson et al did suggest a benefit. Randomized prospective studies on the topic are sparse.
Potential benefits of performing adjunctive PCI on an open artery followin gfibrinolytic administration include:
- Further flow improvements to limit ongoing ischemia
- Redcuction in the risk of recurrent myocardial infarction, particulary if a stent is placed