Decision-making: Stenting in acute myocardial infarction

Percutaneous coronary intervention (PCI) plays a pivotal role in the management of patients with acute myocardial infarction (AMI). Rapid revascularization of the patient with evolving AMI results in reduced rates of mortality, reinfarction and greater myocardial salvage with smaller infarct size. Since the performance of the first balloon angioplasty in 1977, remarkable advances have improved the safety and efficacy of PCI. Advances in stent technology and adjunct pharmacology have improved the outcomes for patients with AMI undergoing primary PCI. Drug-eluting stents result in a significant reduction in the clinical and angiographic rates of restenosis. Early concerns of stent thrombosis in the AMI setting have been allayed by recent results from numerous randomized clinical trials and observational studies. Reduced ischemic and hemorrhagic complications from new antithrombin and antiplatelet agents have further reduced mortality and improved event-free survival after primary PCI.