Interpretation:

Among patients with ST elevation MI, treatment with facilitated PCI or primary PCI resulted in similar infarct size and early myocardial perfusion by ST resolution, although later ST resolution was improved in the faciliated PCI arm as was epicardial flow. Primary PCI has been shown to be an effective alternative to medical therapy alone in STEMI patients. However, the major limitation to such therapy is limited availability as well as the time delay to transfer and treat the patient in the catheterization lab. Given these limitations, facilitated therapy with early thrombolytic followed by a moderately delayed intervention has been suggested as an alternative to achieve early reperfusion (lytic) followed by more complete reperfusion (PCI). The potential for increased bleeding with facilitated PCI did not occurr in the present trial, although the sample size was small and the study was not powered for safety. The ASSENT-4 PCI trial, which also evaluated facilitated PCI and primary PCI, was discontinued early after increased mortality was observed with facilitated PCI in an interim analysis. However, there are several differences in the study design of ASSENT-4, including only a short delay in time from lytic to PCI in the facilitated group, optional clopidogrel use, and prohibition of GP IIb/IIIa inhibitor use in the facilitated PCI group.