Logistics of Primary Angioplasty

Aims: After many years of debate, primary angioplasty has emerged as the best reperfusion treatment for acute myocardial infarction (AMI). However, the scarce availability of qualified invasive facilities remains the major limitation of this strategy compared to the simple intravenous administration of effective lytic agents. Methods: To enlarge the availability of invasive centers where patients with AMI could be promptly treated with primary angioplasty two lines of action may be pursued; the first is the ‘up-grading’ of low-volume interventional or diagnostic laboratories that do not perform emergency interventions on a regular basis; the second is the creation of a transportation network that enables pre-hospital fibrinolysis and/or the referral of patients from non-invasive centers to high-volume tertiary structures committed to the treatment of AMI at any time. Results: Recent data obtained from randomized studies support both alternatives. In fact, pre-hospital fibrinolysis and transportation or patient transportation without previous fibrinolysis are safe and offer better clinical outcome compared to fibrinolysis started in hospital. Besides, primary angioplasty can also be performed in selected community centers intensively trained that, performing large work volumes, can achieve superior results compared to fibrinolysis started in hospital. Conclusions: The advantages and shortcomings of these two alternatives are commented on in this article