Angioplasty after thrombolysis in the treatment of evolving myocardial infarction.
Potent pharmacological agents that rapidly induce coronary thrombolysis reduce morbidity and mortality from evolving myocardial infarction especially when administered early after the onset of ischemia. However, recanalization frequently unmasks residual, high-grade stenoses that can impair reflow, predispose to reocclusion, and limit salvage of myocardium. Coronary angioplasty performed immediately after recanalization induced by thrombolysis reduces the severity of stenosis and can enhance salvage. Unfortunately, complication rates are higher with emergency compared with delayed angioplasty. Thus, mechanical recanalization early after thrombolysis should be reserved for patients with signs or symptoms of recurrent ischemia or for those in whom pharmacological recanalization has failed but a large amount of myocardium remains at risk.
Bergmann
S R
SR
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110.
Sobel
B E
BE
D000800:Angioplasty, Balloon; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*
D005343:Fibrinolytic Agents