The role of coronary angioplasty in the treatment of patients with acute myocardial infarction: one interventional cardiologist's opinion.
The role of percutaneous transluminal coronary angioplasty (PTCA) in patients with evolving or a recent acute myocardial infarction (AMI) continues to be defined. PTCA can be applied in most patients with AMI, but recent controlled trials have shown it will play a more supplemental role to intravenous thrombolysis than previously predicted. PTCA is useful in the immediate treatment of AMI patients with cardiogenic shock, those with contraindications to thrombolytic therapy, those with no clinical response to thrombolytic therapy, and perhaps in those in whom the AMI-related artery remain occluded. During the convalescent phase of AMI, PTCA is useful in patients with recurrent ischemia whether or not thrombolytic therapy was given initially. The percentage of patients with recurrent ischemia will vary depending on how vigorously it is searched for. For example, more patients will be identified if myocardial perfusion scanning is combined with predischarge stress testing than with stress testing alone, which in turn would identify more patients than with ischemia occurring only spontaneously. Whether all patients with "recurrent ischemia" should undergo further evaluation, whether or not ischemia is controlled with antianginal therapy, has not been definitively studied; but my response is in the affirmative.
Feldman
R L
RL
University of Florida, Gainesville.
D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator