[Percutaneous transluminal coronary angioplasty following thrombolysis in acute myocardial infarct].
The technique of combined medical and mechanical recanalization in acute myocardial infarction increases the reperfusion rate of occluded coronary vessels from 50% to 75% up to 90%. According to retrospectively performed analysis the reocclusion rate can be reduced at the same time from 17%-25% to about 7%-14%. The duration of occlusion of the coronary artery and the residual coronary stenosis following reperfusion are the main determinants of infarct size. The mechanical recanalization achieved by PTCA following thrombolysis improves the coronary flow and thus reduces infarct size, as demonstrated in experimental studies. Similar results can be expected in man as well. Indirect evidence has been demonstrated by ventriculographic and scintigraphic analysis of global and regional ventricular function. The time interval between successful thrombolysis and PTCA should be short, at least not longer than 5 days, because of the implications of residual stenosis for coronary flow and resulting infarct size and the incidence of reocclusion of the coronary vessel in the first few days following thrombolysis. In order to reduce the risk of reocclusion due to residual stenosis or residual coronary thrombi sufficient heparinization and anticoagulation is necessary. Cardiogenic shock in acute myocardial infarction represents a serious complication which is lethal in about 70%-80%. In these cases the technique of PTCA combined with thrombolysis may reduce mortality considerably to about 30%.(ABSTRACT TRUNCATED AT 250 WORDS)
Erbel
R
R
II. Medizinische Klinik und Poliklinik, Klinikum der Johannes-Gutenberg-Universität, Mainz.
Pop
T
T
Meyer
J
J
D000800:Angioplasty, Balloon; D003131:Combined Modality Therapy; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D011379:Prognosis
D005343:Fibrinolytic Agents
PTCA nach Thrombolyse beim akuten Myokardinfarkt.