Are Stenting and Glycoprotein IIb/IIIa Blockade of Good Value in Primary Percutaneous Coronary Intervention?

Therapy for ST-elevation acute myocardial infarction(STEMI) has undergone remarkable change over thepast decade, and more evolution is doubtless in store. First, it has become relatively clear that primary angioplasty provides a real, if small, benefit over thrombolytic therapy.1 More recently, clinical trial data have shown that coronary stenting, initially thought to be unsafe in the thrombotic setting of an STEMI, is indeed safe and provides for a reduction in early events and repeat revascularization, al-though there was lingering concern over possible increased mortality with stenting compared with balloon angioplasty.2 Finally, some have argued recently that glycoprotein IIb/IIIa inhibitors also provide a benefit over conventional anticoag-ulation regimens.3–5 See p 2857 However, despite the potential benefits that each of these therapies may offer, each new therapy is also expensive, and