The risk of reperfusion strategies in the treatment of patients with acute myocardial infarction.
Coronary reperfusion early after the onset of acute myocardial infarction can restore vessel patency, improve ventricular function and reduce short- and long-term mortality. A number of reperfusion methods have been used to achieve vessel patency in acute myocardial infarction, but each strategy varies considerably in its risk to the patient. Intravenous thrombolysis is associated with an 8% risk of major or minor bleeding and a less than 0.5% risk of intracranial bleeding. This latter risk has been reported to be 1.5% when 150 rather than 100 mg of intravenous recombinant tissue-type plasminogen activator (rt-PA) is used. Invasive procedures such as cardiac catheterization, coronary angioplasty and intraaortic balloon pumping significantly increased the risk of major bleeding at the vascular entry site (from 20 to 40%). Clinical factors such as older age, female gender, lower body weight and hematologic variables including nadir fibrinogen levels and fibrin degradation products also relate to an increased risk. Coronary angioplasty performed alone without thrombolysis is not associated with an excess risk of bleeding and appears to have complications similar to those reported for angioplasty in patients undergoing elective procedures. Systemic anticoagulation has a low (less than 2%) incidence of bleeding, and serious bleeding is rare. These risks must be considered in the decision to institute a treatment strategy in patients with acute myocardial infarction.
Faxon
D P
DP
Evans Memorial Department of Clinical Research, University Hospital, Boston, Massachusetts 02118.
D000800:Angioplasty, Balloon / Q000009:adverse effects* / Q000401:mortality; D000925:Anticoagulants / Q000009:adverse effects; D002986:Clinical Trials as Topic; D005343:Fibrinolytic Agents / Q000009:adverse effects*; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D015337:Multicenter Studies as Topic; D009203:Myocardial Infarction / Q000628:therapy*; D012008:Recurrence
D000925:Anticoagulants; D005343:Fibrinolytic Agents