[Indications of coronary angioplasty after thrombolysis].
Thrombolysis is the most widely used method of coronary reperfusion in the acute phase of myocardial infarction. The indications of angioplasty after thrombolysis have been subject of considerable controversy over the last few years. Three randomised trials (TIMI 2, TAMI, ECSG) have shown that it is not desirable to perform systematic immediate angioplasty after intravenous thrombolysis with rt-PA. Angioplasty may be carried out as a "salvage" procedure in cases of failure of thrombolysis. The validity of this approach was confirmed recently by the "RESCUE" trial in anterior myocardial infarction. The practical application of its results is confronted by logistical problems inherent to the practice of angioplasty in the acute phase of myocardial infarction and to the inadequacy of non-invasive methods for the detection of coronary reperfusion after thrombolysis. Angioplasty may also be necessary in cases of left ventricular failure or cardiogenic shock. The efficacy of a rapid angioplasty in cases of recurrence of ischaemia after thrombolysis has been proved in reducing mortality and preserving left ventricular function. The results of TIMI IIB and SWIFT trials show that secondary angioplasty, several days after thrombolysis, is only usually indicated in patients with residual clinical ischaemia or positive stress tests. This attitude should however be modulated in the light of the "open artery" theory and the limitations of methods of evaluating myocardial viability. The present strategies will no doubt be modified with the introduction of new thrombolytic and/or antithrombotic agents and the use of coronary stents.
Vahanian
A
A
Service de cardiologie, hôpital Tenon, Paris.
Garbarz
E
E
Nallet
O
O
Porte
J M
JM
Michel
P L
PL
Maroni
J P
JP
Louvard
Y
Y
Jais
J M
JM
D015906:Angioplasty, Balloon, Coronary; D004630:Emergencies; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D015912:Thrombolytic Therapy; D013997:Time Factors