Stents in acute myocardial infarction

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It has been widely reported throughout studies comparing mechanical reperfusion by primary percutaneous transluminal coronary angioplasty (PTCA) with thrombolytic therapy in acute myocardial infarction (AMI) that PTCA results in reduced rates of in-hospital mortality, reinfarction, recurrent ischemia, and stroke, allowing earlier hospital discharge with similar total costs. The attraction of primary PTCA is its relative simplicity and predictability with operators who have a wide range of experience with PTCA. With these results, it is legitimate to wonder what, if any, possible advantages other reperfusion approaches, such as stenting, might offer compared with primary PTCA. In addition, there is concern that newer reperfusion modalities may complicate an otherwise straightforward procedure and increase hospital expenditures. However, as effective as primary PTCA is, there is still room for improvement. Limitations of reperfusion by primary PTCA in AMI include recurrent ischemia in 10% to 1 5% of patients, restenosis in 37% to 49%, and late infarct artery reocclusion in 9% to 14%. By reducing the residual stenosis and sealing dissection planes created by PTCA, primary stenting may further improve short- and long-term outcomes after mechanical reperfusion. Consequently, interest in using stents in the setting of AMI has increased dramatically in the past several years. The results of various recent clinical studies confirm that primary stenting is safe and reasonable in the majority of patients with AMI and produces short-term outcomes superior to experience with primary PTCA.

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