ABSTRACT
PRIMARY PCI AND BLEEDING COMPLICATIONS: THE URGE FOR A SOLUTION According to the recent guidelines, primary percutaneous coronary intervention (PCI), when performed within 12 hours of symptom onset, in a timely fashion (balloon inflation within 90 minutes of presentation), and by persons skilled in the procedure, is the established treatment for ST-elevation acute myocardial infarction (STEMI) (1). In addition, for those patients still receiving thrombolysis, a rescue PCI is considered a valuable option, in case of failed reperfusion and ongoing or recurrent myocardial ischemia. Even when not receiving thrombolytics (both by rescue PCI and/or in the attempt to facilitate reperfusion prior to primary PCI), all patients undergoing primary PCI will also be expected to receive a broad spectrum of anticoagulants and antiplatelet agents, such as heparin (unfractionated or low molecular weight), bivalirudin, clopidogrel, aspirin, and glycoprotein (GP) IIb/IIIa inhibitors. Unfortunately, while the use of intense anticoagulation and antiplatelet therapy has proven to reduce short-and longterm ischemic events after primary PCI, it also has raised the issue of increased bleeding complications, which occur, in most patients, at the site of vascular access. Despite the miniaturization of catheters, and the advent of hemostatic devices, the incidence of access-site-related bleeding complications accounts for up to 10% of the cases performed by the conventional transfemoral approach (TFA), with a strong negative impact not only on in-hospital morbidity, but also on mid-and long-term survival (2).
