Key Points Catheter-based primary percutaneous coronary intervention (PPCI) has become the mainstay of reperfusion therapy in patients with ST-elevation myocardial infarction (STEMI). PPCI is superior to thrombolytic therapy in reducing death, reinfarction, intracranial bleeding, reocclusion of the infarct-related artery, and…
Key Points All patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS) need to undergo risk stratification at the time of diagnosis. Risk stratification provides prognostic value and helps guide the therapeutic decision-making process. Immediate angiography within 2 hours is recommended…
Key Points Chronic angina is a growing worldwide problem with significant economic and societal costs. By reducing the ischemic burden, percutaneous coronary revascularization provides important clinical benefit in patients with established obstructive coronary artery disease (CAD). The foremost effect is…
Key Points Drug-coated balloon (DCB) catheters are the most advanced proven alternative to drug-eluting stents for local intravascular drug delivery. Preclinical data indicate effective inhibition of restenosis; however, there is no uniform class effect on drug-coated balloons. Randomized clinical trials…
Key Points Bioresorbable scaffolds (BRS) have the potential to overcome the remaining limitations of new generation drug eluting stents (DES) by providing temporary vessel scaffolding and then disappearing. They are composed of either polymer or corrodible metal-based alloys and the…
Key Points Bare-metal stents (BMS) overcome many of the drawbacks of balloon angioplasty but are limited by restenosis, which develops in 20% to 40% of cases. Drug-eluting stents (DES)—which consist of a metallic stent coated with a drug carrier vehicle…
Key Points Access selection is a key decision that should encompass patient comfort, but ultimately be driven by the complexity of the case and operator confidence. Proper guide selection to ensure good support is key to any percutaneous coronary intervention.…
Key Points β-Blockers provide long-term mortality reduction after myocardial infarction (MI). Although β-blockers are beneficial, they should be used carefully immediately after MI to avoid cardiogenic shock in susceptible patients. Calcium-channel blockers are reasonable alternatives to β-blockers after MI in…
Key Points Thrombolytic therapy remains the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI) who present within 12 hours of symptom onset when timely primary percutaneous coronary intervention (PCI) is not available and no contraindications to thrombolysis are…
Key Points Platelets and coagulation play a synergistic role in the generation of thrombus. Improved antithrombin approaches reduce the dependence on antiplatelet therapy for achieving suppression of ischemic events. Although the impact of ischemic events on late mortality is well…