Interventional therapy in acute myocardial infarction.
Large multicenter trials have shown an improvement in both survival and left ventricular function in patients undergoing reperfusion therapy in acute myocardial infarction. The most practical approach in treatment of patients with acute myocardial infarction involves intravenous administration of effective thrombolytic agents as soon as possible in the course of myocardial infarction. This approach using r-tPA results in reperfusion in approximately two-thirds of patients. In patients with contraindications to thrombolytic therapy and extensive injury current or hemodynamic compromise, emergent cardiac catheterization should be performed followed by immediate PTCA or bypass surgery. In patients who have already been treated with thrombolytic agents, controversy exists as to the optimal timing of cardiac catheterization to define coronary anatomy and the need for additional revascularization. We suggest that the most beneficial therapeutic strategy for the majority of patients is rapid administration of an effective intravenous thrombolytic agent combined with aspirin and heparin. Cardiac catheterization and PTCA or coronary artery bypass graft surgery may be deferred in stable patients. This approach is supported by evidence showing a lack of additional improvement in mortality and left ventricular function in patients treated with urgent PTCA. The advent of new therapeutic modalities in acute myocardial infarction, such as thrombolysis, has created a new subset of patients who either will have an improved prognosis if coronary artery reperfusion is completed or will have an increased risk for recurrent myocardial ischemia if definite revascularization is delayed.
Zalewski
A
A
Goldberg
S
S
D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D015425:Myocardial Reperfusion; D012008:Recurrence
D005343:Fibrinolytic Agents