[Is coronary angioplasty the best treatment of acute myocardial infarction?].
Although the efficacy and simplicity of intravenous thrombolysis makes it the gold-standard for the treatment of acute myocardial infarction, coronary angioplasty remains a valuable alternative. Thrombolysis has the disadvantage of increasing the risk of haemorrhage and is contraindicated in many cases. In addition, thrombolysis appears to have little effect on prognosis in patients with an infarction complicated by cardiogenic shock or those with an occlusion of the venous graft. Finally, when the electrocardiographic findings are not patent, the benefit/risk ratio may be uncertain. Many patients with an acute myocardial infarction are thus totally excluded from thrombolysis making this required selection the main limitation of the treatment. In all these situations, the only effective treatment is primary or direct coronary angioplasty. Major series of patients treated with primary angioplasty have shown that the treatment can be effective on coronary permeability, preservation of ventricular function and short and long-term survival. Several other comparative and randomized studies have confirmed that coronary angioplasty can be an effective alternative, in particular in high-risk patients (elderly subjects, anterior infarctions, women). Finally, the economic data available tend to show that costs for angioplasty are lower than the costs of thrombolysis due to the reduction of hospitalization time and number of readmissions. In conclusion, coronary angioplasty is certainly the best treatment for acute myocardial infarction, at least for the most severe cases and often the only possible option for those with a contraindication for thrombolysis. Operational requirements mean that cardiology emergency facilities will have to be adapted to provide coronary angioplasty 24 hours a day in experienced interventional centres. At the present time, well-managed pre-hospital screening to identify patients with an indication for coronary angioplasty should allow emergency transportation to currently operating centres.
Himbert
D
D
Service de Cardiologie A, Hôpital Bichat, Paris.
Juliard
J M
JM
Steg
P G
PG
D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D012307:Risk Factors; D012737:Sex Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects
L'angioplastie coronaire est-elle le meilleur traitement de l'infarctus aigu du myocarde?