[Angioplasty or fibrinolytic therapy in acute myocardial infarction with ST elevation?].
Early and complete opening of the thrombotic occluded coronary artery is the best treatment of acute myocardial infarction with ST-segment elevation in ECG. Mechanical reperfusion with coronary angioplasty and pharmacological opening with fibrinolytic drugs are alternative therapies. Primary coronary angioplasty is the best therapy in hospitals with the necessary facilities, giving lower mortality, less reinfarction and stroke. Patients with transport time of less than 90 minutes should be treated with angioplasty. Patients in need of longer transport should have fibrinolytic therapy in their local hospital. The patient should be given analgesics and acetylsalicylic acid before transport to hospital. The value of prehospital fibrinolytic therapy and the use of glucoprotein IIb/IIIa receptor inhibitors before transport are disputed. After failed fibrinolytic treatment, rescue angioplasty can be done with good outcomes.
Vik-Mo
Harald
H
Hjertemedisinsk avdeling, St. Olavs Hospital, 7006 Trondheim. harald.vik-mo@medisin.ntnu.no
D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D004632:Emergency Medical Services; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D017410:Practice Guidelines as Topic; D015912:Thrombolytic Therapy; D014187:Transportation of Patients
D005343:Fibrinolytic Agents