[Acute myocardial infarction: pharmacological reperfusion or angioplasty?].
For patients with acute myocardial infarction intravenous thrombolytic therapy has become the standard care in restoring patency of the infarct-related coronary artery. Nearly 200.000 patients have been involved in thrombolytic trials over the last decade. A significant decreases in short-term mortality has been shown for those patients who are eligible for treatment with thrombolytics. However, in approximately 20% of patients patency is not achieved, a high-grade residual coronary stenosis is left, reocclusion of the open vessel, an increased incidence of recurrent ischemia and serious bleeding complications can occur with this therapeutic modality, resulting in increased morbidity and mortality. There is an increasing interest in immediate angioplasty as an alternative to thrombolytic reperfusion during the first hours in patients with acute myocardial infarction hospitalized in those institutions that have the capability of performing angioplasty on an emergency basis. It has been shown that immediate angioplasty restored antegrade coronary perfusion in more than 90% and in 85 to 90% a complete blood flow (grade 3 by criteria of the TIMI trial) is achieved. Treatment of the residual coronary stenosis prevents recurrent isquemia, reduces the occurrence of nonfatal reinfarction, and fewer readmissions can be expected. Finally, angioplasty also provides a view of the coronary anatomy and identifies patients at high risk, some of whom need emergency bypass surgery, or patients with low risk who need a shorter hospital stay.
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Kauffmann
D017130:Angioplasty; D000075202:Contraindications; D003422:Critical Care; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000601:surgery*; D015912:Thrombolytic Therapy
Infarto agudo del miocardio: reperfusión farmacológica o angioplástica?