EDITORIAL

Mechanical reperfusion therapy for acute myocardial infarction: Stent PAMI, ADMIRAL, CADILLAC and beyond

B R Brodie, T D Stuckey

Greensboro, North Carolina, USA

Correspondence to:
Correspondence to:
Dr BR Brodie, 313 Meadowbrook Terrace, Greensboro, NC 27408-6529, USA
cvresearch@aol.com

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Mechanical reperfusion has gained increasing acceptance as a reperfusion strategy for acute myocardial infarction

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Keywords: mechanical reperfusion; acute myocardial function; stents; glycoprotein IIb/IIIa inhibitors

Abbreviations: ADMIRAL, abciximab before direct angioplasty and stenting in myocardial infarction regarding acute and long-term follow-up; AMI, acute myocardial infarction; CADILLAC, controlled abciximab and device investigation to lower late angioplasty complications; FINESSE, facilitated intervention with enhanced reperfusion speed to stop events; GUSTO, global use of strategies to open occluded coronary arteries; MACE, major adverse cardiac events; PAMI, primary angioplasty in myocardial infarction; PCI, percutaneous coronary intervention; SAFER, saphenous vein graft angioplasty free of emboli randomized trial; SPEED, strategies for patency enhancement in the emergency department; TIMI, thrombolysis in myocardial infarction; TVR, target vessel revascularisation

Mechanical reperfusion has gained increas ing acceptance as a reperfusion strategy for acute myocardial infarction (AMI) as a result of data from numerous randomised trials showing superior outcomes. Recently, the Stent PAMI, ADMIRAL, and CADILLAC trials have documented further improvement in outcomes with the addition of adjunctive treatment with coronary stents and platelet glycoprotein IIb/IIIa inhibitors.^1–3 Grines and colleagues, in the Stent PAMI trial, found that stents reduced target vessel revascularisation (TVR) and major adverse cardiac events (MACE) at six months compared to balloon angioplasty alone.¹ (The Stent PAMI trial initially raised some concerns because the incidence of TIMI 3 flow was slightly lower following stenting versus balloon angioplasty, and there was a disturbing trend toward higher mortality in stented patients at six months. These concerns were resolved in the CADILLAC trial). Montalescot and colleagues, in the ADMIRAL trial, found that the use of the platelet glycoprotein IIb/IIIa inhibitor abciximab . . . [Full text of this article]

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