The case for early direct myocardial reperfusion.
The treatment of choice, in Des Moines, Iowa for evolving myocardial infarction, is emergency reperfusion by medical or surgical means that are appropriate to the individual patient. If the patient exhibits clinical evidence of continuing evolution at any time distance from the onset of chest pain, cardiac catheterization is done immediately. With single vessel disease, streptokinase lysis is attempted and augmented when necessary by percutaneous transluminal coronary angioplasty. If multiple vessel disease is present, surgical intervention is carried out immediately. As mentioned above, time is not a predictor as to the final outcome whereas the endocardial ventricular architecture correlates well with wall motion recovery. This therapeutic protocol has resulted in an overall mortality rate of 3.5% in patients with evolving myocardial infarction. As mentioned above, all deaths occurred in the patients who were in cardiogenic shock before therapy, and all other 303 patients with evolving myocardial infarction recovered. We certainly do not discourage controlled clinical trials, utilizing these and other techniques, but do encourage you to adopt reperfusion as the primary therapy for evolving myocardial infarction for your patients.
D000800:Angioplasty, Balloon; D006328:Cardiac Catheterization; D003326:Coronary Circulation; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000628:therapy; D013300:Streptokinase / Q000627:therapeutic use
D013300:Streptokinase