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Rise and fall of glycoprotein IIb–IIIa inhibitors in ST-segment elevation myocardial infarction
  1. Carlo Di Mario
  1. Correspondence to Professor Carlo Di Mario, Department of Cardiology, NIHR Cardiovascular BRU, Royal Brompton Hospital & NHLI Imperial College, London, UK; SW3 6NP c.dimario{at}rbht.nhs.uk

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The Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI)1 is the largest study in the family of trials2 ,3 that led to modification in guidelines4 and clinical practice in patients receiving fibrinolysis for ST-segment elevation myocardial infarction (STEMI). Before these trials, even proponents of primary angioplasty were reluctant to intervene after fibrinolytic therapy unless there was clear evidence of failed reperfusion. After these trials, direct transfer to an angioplasty centre after initiation of fibrinolytic therapy with early angiography (within 24 h) has become routine for patients living too far from a primary angioplasty centre to receive angioplasty within 90 min. However, it is likely that the effects of advances in angioplasty techniques relevant to the STEMI population—such as the routine use of stents, the radial artery approach and mechanical thrombectomy—are less relevant to the continued improvement in outcomes after STEMI than the advances in periprocedural antiplatelet regimens. …

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