[PTCA for acute coronary syndrome].
The use of intravenous thrombolytic therapy have revolutionized the medical management of acute MI, prolonging survival and preserving LV function. Yet, despite these important beneficial effects, many deficiencies exist, such as the fewer lytic eligible patients, the low rate of complete reperfusion and high incidence of recurrent Ischemia and intracranial hemorrhage. To improve on these deficiencies, several PTCA strategies for acute MI have emerged, including primary PTCA, rescue PTCA, immediate PTCA, and delayed PTCA. If skilled intervention-list and cath lab team are available, the optimal reperfusion strategy is primary PTCA. If a cath lab is not available and the patient is eligible for thrombolysis, intravenous thrombolytic therapy should be administered. Nevertheless, PTCA still has significant limitations, including complex lesion morphology and restenosis. Preliminary experience support the feasibility and safety of coronary stenting in the setting of acute MI. A randomized trial using the heparin-coated Palmaz-Schatz stent for primary stenting in MI is ongoing. Until a randomized trial data are available, we recommend stenting for provisional stenting.
Nobuyoshi
M
M
Department of Cardiology, Kokura Memorial Hospital.
Yokoi
H
H
Nakagawa
Y
Y
Kaitani
K
K
D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D001241:Aspirin / Q000627:therapeutic use; D003327:Coronary Disease / Q000628:therapy*; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D013577:Syndrome; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator; D001241:Aspirin