ne of the most important factors influencing the success of treatment of acute myocardial infarction (AMI) is the speed with which revascularization of the involved coronary arteries can be accomplished. According to the guidelines issued by the American Heart Association (AHA) and American College of Cardiology (ACC), patients under 75 years of age with myocardial infarction should be administered thrombolytic therapy within 30 min of "Door-to-Needle" time, or by percutaneous coronary intervention (PCI) within 90±30 min of "Door-toBalloon" time. [1][2][3][4] Since a report of favorable outcomes in the PACT trial, 5 facilitated PCI, in which PCI is conducted after anticipatory administration of thrombolytic therapy, has been drawing attention. 6-8 Facilitated PCI is considered to be a promising treatment strategy, based on the following consideration; the overall therapeutic outcome of AMI may be improved even at institutions where PCI cannot be Circulation Journal Vol.68, December 2004 performed, since a therapeutic outcome equivalent to or superior to that obtained by primary PCI may be achieved by anticipatory administration of a thrombolytic agent, followed by PCI at a suitable institution after the transfer of the patient. Group involved in the present study has devised a treatment strategy consisting of FAST therapy for patients in whom a diagnosis of AMI can be made immediately after arrival at the hospital. In the FAST therapy, intravenous administration of a mutant tissue-type plasminogen activator (t-PA), which can be administered rapidly as a bolus injection, is followed by coronary angiography, and then, PCI is conducted in patients in whom TIMI-3 has not been achieved as evaluated by the coronary angiography (CAG). The present study group has reported a favorable therapeutic outcome of this trial. FAST therapy, including FAST-1, 9 and FAST-2, 10 in which t-PA or mutant t-PA is used, reduced the incidence of myocardial damage with the risk of complications. In the FAST-3 trial, in which the relationship between the "Door-to-TIMI-3" time and the extent of myocardial salvage was also assessed, 11 the "Door-to-TIMI-3" time was confirmed to have considerable influence on the extent of the infarction, and based on the results of the trial, a "Door-to-TIMI-3" time of 55 min was recommended. Taking into consideration the present situation in Japan, in which the age of the population is steadily increasing, we investigated the limitations of the FAST-3 therapy imposed by age, the safety of the treatment protocol in various age groups, and the indications for the FAST-3 protocol. Background The purpose of the present study was to evaluate the efficacy and safety of facilitated percutaneous coronary intervention (PCI) in comparing young and elderly patients with acute myocardial infarction.
Methods and ResultsThe present study enrolled 168 initial myocardial infarction patients within 12 h of the symptom onset between 40 and 80 years of age who were indicated on the fibrinolysis and subsequent transluminal ...