Current status and future prospects for acute myocardial infarction therapy.
Considerable new evidence has accumulated in randomized trials of myocardial reperfusion. The trials of catheter-based reperfusion compared with fibrinolytics have shown an advantage for angioplasty and stenting over pharmacologic therapy, even accounting for delays in transporting patients from facilities with intervention capabilities. On the basis of the recent trials, it is recommended that a regional center for infarct intervention be set up akin to regional trauma centers in the United States. Now that we have entered the third decade of myocardial reperfusion therapy, we can expect iterative improvement in all aspects, and ultimately a fused approach of pharmacology and mechanical therapies-to achieve the optimal outcomes and continue to lower the toll of fatality and morbidity of acute myocardial infarction (MI).
Topol
Eric J
EJ
Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F-25, Cleveland, OH 44195, USA. topole@ccf.org
D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D004617:Embolism / Q000517:prevention & control; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic; D012038:Regeneration; D012041:Regional Medical Programs; D033581:Stem Cell Transplantation; D015912:Thrombolytic Therapy; D014187:Transportation of Patients
D000925:Anticoagulants; D019039:Platelet Glycoprotein GPIIb-IIIa Complex