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In patients with ST-segment-elevation MI (STEMI), facilitated percutaneous coronary intervention (PCI) — i.e., early pharmacologic reperfusion therapy followed by immediate mechanical revascularization — has not shown clear benefits in preliminary studies. Still, ACC/AHA PCI guidelines give it a class IIb recommendation in higher-risk patients when PCI is not immediately available and bleeding risk is low (Journal Watch Cardiology Jan 12 2006). Two new studies provide clearer data on facilitated PCI.
In the industry-funded ASSENT-4 PCI trial, 1667 patients with STEMI of <6 hours’ duration were randomly assigned to standard PCI or PCI preceded by full-dose tenecteplase. All patients received aspirin plus a bolus of unfractionated heparin (wit…