PCI after lytic therapy: when and how?

Primary percutaneous coronary intervention (PCI) and thrombolysis are approved therapies in the treatment of ST-elevation myocardial infarction (STEMI). Many clinical trials have shown that primary PCI provides better results than thrombolysis for the STEMI treatment. However, the advantages of invasive approach over fibrinolytic therapy may be blunted by low availability of experienced centres offering 24 h/7 days primary PCI service and by delay to mechanical reperfusion due to prolonged transport. Current guidelines recommend that primary PCI should be performed by skilled professionals within less than 90 (120) min after first medical contact. In practice, these requirements prohibit a large number of STEMI patients from benefiting from primary PCI because of the lack of access to an established primary PCI centre at the site of first presentation and long anticipated interhospital transfer time. Many of them are treated with lytics and referred to angiography with subsequent PCI in different time mode. Current data support the strategy of immediate PCI after lytics than waiting for rescue PCI if lysis is non-effective. The purpose of this article is to review the current approaches to patients after fibrynolytic therapy referred for PCI for STEMI.