The Use of Percutaneous Coronary Intervention (PCI) for Heart Attack A Critique

PCI has recently become the treatment of choice for acute myocardial infarction (AMI), an emergency procedure in which time to reperfusion of the ischemic myocardium should be as short as possible because the ischemic damage rapidly becomes irreversible. Therefore, the choice of PCI for AMI is difficult to understand, since PCI is a complicated, time-consuming hospital procedure, whereas fibrinolysis, the alternative, which PCI replaced, is so much simpler and faster. PCI requires an arterial catheterization in a hospital which takes time and is costly, whereas fibrinolysis requires only an intravenous injection or infusion, that is simple, fast and low cost. In contrast to PCI, fibrinolysis also perfuses all size vessels and is not limited to arteries larger than the size of the catheter. In view of this disparity between the two treatments, how did a timeconsuming procedure like PCI succeed to show that it was more effective than a rapidly delivered treatment like fibrinolysis for an emergency like AMI where the time to reperfusion is the ultimate criterion of success.