Primary Angioplasty in Acute Myocardial Infarction [antikvár]

Preface Over the past 50 years, care of the patient sustaining an acute myocardial infarction has undergone a stunning evolution. In the early days, there was little to offer the patient with an acute infarction except for weeks of absolute bedrest, and substantial morbidity and high rates of mortality were the norm. Just 15 years ago, thrombolytic therapies were being introduced as a pharmacologic approach to treat the acute event more aggressively and, fortunately, more successfully. About the same time, a few brave pioneers asked the question, why not perform emergency angioplasty as a primary reperfusion strategy? These individuals, despite being thought of as heretical by mainstream cardiology, nonetheless persevered, proving the benefit of "state of the art" balloon angioplasty compared to "state of the art" thrombolytic therapy in a series of landmark trials published in the New England Journal of Medicine in 1993. Since then, there has been no turning back, and today the technique has evolved to incorporate a multifaceted approach including the best of angioplasty technologies coupled with a rich and growing armamentarium of adjunctive medications, all designed to opdmize both short- and long-term outcomes. It is a pleasure to bring together in this volume the best available data about direct percutaneous coronary intervention (PCI) as primary treatment of acute myocardial infarction. The first three chapters provide critical background information about the lexicon and requirements personnel and institutions must understand and fulfill to have a safe and successful program. The next two chapters tell the early history of direct PCI, including a review of the inauspicious beginnings in plain old balloon angioplasty and how these beginnings led to current stent PCI strategies; a second chapter discusses the use of emergency PCI as a bailout procedure for failed thrombolysis. Chapters 6-9 survey the contemporary strategies that define direct PCI today, including the growing movement to institute direct PCI programs in hospitals that do not have full-time surgical backup; adjuncdve therapies aimed at reducing reperfusion injury and maintaining TIMI grade 3 flow; the potent platelet inhibitors known as glycoprotein (GP) Ilb/IIIa receptor inhibitors and their role in PCI; and the randomized clinical trial evaluations of stent implantation and GP Ilb/IIIa inhibitors singulady and in combination. The final chapter fills in the economic justification for a medical procedure that could arguably be recommended to as many as half a million patients in the United States per year. I am grateful to my colleagues, the authors of the chapters in this book, for their willingness to share their knowledge, their research, and their insights. In an age when any time spent away from research and practice is precious, it is a tribute to their dedicadon to the highest quality clinical care that they were