ABSTRACT
The early evolution of coronary thrombolysis and of primary balloon angioplasty for the treatment of STEMI led to an unfortunate dichotomy. What resulted from initial attempts to combine the two was a strict adherence by particular practitioners to either a pharmacological or mechanical approach rather than to one combining the two modalities. Subsequently, advances in the pharmacology of coronary thrombolysis and in percutaneous coronary intervention (PCI) set the stage for revisiting the possibility that combined therapy would be particularly beneficial. As pointed out in several chapters preceding this one, strict adherence to either a pharmacological or mechanical approach for treatment of STEMI entails inherent limitations that appear likely to
be obviated by pharmacoinvasive therapy. The developments addressed in Chapters 1, 6, and 8 have rendered obsolete initial fears of combining pharmacological and mechanical approaches. In addition, they have supported the likelihood that prompt, pharmacologically induced recanalization and consolidation of benefit with PCI is an optimal strategy for treatment of many patients with STEMI.
