ABSTRACT: Aims. We sought to compare a routine invasive strategy of early coronary angiography and intended revascularization, with an ischemia-guided strategy in patients with acute inferior ST-elevation myocardial infarction (STEMI) who received fibrinolytic therapy. Methods. We enrolled 60 consecutive patients with acute inferior STEMI who received fibrinolytic therapy within 6 hours.

Percutaneous coronary intervention (PCI) of an aorto-ostial lesion requires precise implantation of a coronary artery stent in order to prevent adverse clinical outcomes. “Geographic miss” occurs when the lesion is not fully covered or additional stents are required, which undoubtedly will contribute to edge restenosis and stent thrombosis. Conversely, over-covering the lesion proximally complicates matters by making it difficult to cannulate the vessel coaxially for future coronary intervention.

The decision of whether to implant a drug-eluting stent (DES) or bare-metal stent (BMS) in potentially the highest “risk” situation, primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction (STEMI), represents, in many ways, an evolution of science and practice. As our understanding of the risks and benefits of DES implantation has progressed, the pendulum of enthusiasm of use may have swung from one extreme to another.