Multiple, large randomised trials comparing primary percutaneous coronary intervention (PCI) with fibrinolytic therapy for ST elevation myocardial infarction (STEMI) have shown that primary PCI results in lower rates of death, reinfarction, and stroke.¹ Consequently, primary PCI has become the preferred reperfusion strategy for STEMI. Unfortunately, primary PCI is available in only a minority of hospitals, and concern that treatment delays inherent in transporting patients from non-interventional hospitals to interventional hospitals may compromise outcomes, has limited the use of primary PCI. Recent trials in Europe have documented superior outcomes in patients with STEMI presenting at non-interventional hospitals when they are transferred to an interventional facility for primary PCI compared with being treated locally with fibrinolytic therapy, despite treatment delays of about one hour.^2,3

Unfortunately, treatment delays in transferring patients from non-interventional to interventional hospitals are often longer than this in the “real world”. This has stimulated interest in combining pharmacological treatment with mechanical reperfusion (facilitated PCI) in an attempt to minimise delays to reperfusion. Facilitated PCI is defined as the use of pharmacological treatment as soon as possible after the onset of STEMI in an attempt to establish early reperfusion, followed by transport to an interventional laboratory for emergent mechanical reperfusion in an attempt to maximise the frequency of TIMI 3 flow in the infarct artery and to stabilise the ruptured plaque with PCI. The facilitated PCI strategy triages all patients to the catheterisation laboratory for PCI following pharmacologic reperfusion therapy, and should be distinguished from rescue PCI, in which only patients who are thought to have unsuccessful reperfusion following pharmacologic reperfusion therapy are transported to the catheterisation laboratory for PCI.

EVIDENCE SUGGESTING BENEFIT OF FACILITATED PCI

Facilitated PCI potentially may improve outcomes over primary PCI alone by establishing earlier reperfusion, by providing an open artery on arrival to the catheterisation laboratory which may …