2) PCI sau khi điều trị fibrinolytic Mặc dù các kết quả đáng thất vọng đạt được trong cuối những năm 1980 với nong mạch tim ngay lập tức sau fibrinolysis tĩnh mạch, các nỗ lực mới đã được thực hiện vào những năm 2000, bởi vì tiến bộ đáng kể đã được thực hiện trong cả hai kỹ thuật nong mạch tim và trong điều trị chống huyết khối adjunctive, và trongđặc biệt là sử dụng kết hợp aspirin, thienopyridine điều trị và glycoprotein IIb / IIIa đường tĩnh mạch thuốc ức chế. | 2 PCI after fibrinolytic treatment In spite of the disappointing results achieved in the late 1980s with angioplasty immediately following intravenous fibrinolysis new attempts were made in the 2000s because considerable progress had been made in both angioplasty techniques and in adjunctive antithrombotic therapy and in particular the combined use of aspirin thienopyridine therapy and intravenous glycoprotein IIb IIIa inhibitors. These attempts were made in two directions improving the efficacy of primary PCI by administering fibrinolytic treatment or GP IIb IIIa inhibitors upfront of the interventional procedure so-called facilitated PCI or improving the result of fibrinolysis by performing subsequent PCI in all or selected patients. Facilitated PCI A number of randomised trials have compared primary PCI with PCI facilitated by either fibrinolytic treatment GP IIb IIIa inhibitors or both. A meta-analysis published in 2006 showed that though more patients assigned to facilitated PCI had initial TIMI 3 flow there was no clinical benefit compared with prim-mary PCI 7 . Recently facilitated PCI was evaluated in two large randomised trials. The ASSENT-4 PCI trial 8 compared primary PCI with PCI immediately preceded by tenecteplase and was stopped prematurely because an excess of events was observed in the facilitated arm and this despite the fact that more patients had an open infarct-related artery before the angioplasty procedure. Two factors may have explained these findings first concomitant antithrombotic therapy may have been insufficient in the tenecteplase arm of the trial with the use of a low dose of heparin and minimal use of GP IIb IIIa inhibitors second PCI was performed soon after administration of fibrinolytic treatment median time 104 minutes at a time when platelet reactivity was still increased. Both factors may have played a role in the excess reinfarction rate observed in the facilitated arm. In the FINESSE trial patients were randomised in a 1 1 1
