[Patient selection for direct and rescue angioplasty]

The definition of the best therapeutic approach to reperfusion in evolving myocardial infarction has led to an important scientific effort in the last 15 years. The efficacy and safety of thrombolytic therapy, known for several years, has been questioned with the introduction of the concept of complete reperfusion, or TIMI III flow, much more frequently achieved with angioplasty. The systematic association of these techniques, with the intention of achieving a better rate of complete reperfusion, was soon abandoned, because this strategy did not improve the overall success rate, and was associated with more major cardiac events. Therefore, with regard the published data available, which does not include the new mechanical and pharmacological approaches, it seems that the relative efficacy of each method depends upon logistic conditions, and only a few well identified groups seem to do better with angioplasty, than with thrombolysis. These are, unquestionably, two very good ways of achieving reperfusion and the goal of our clinical expertise should be to be able to choose the best therapeutic approach for each patient with evolving myocardial infarction.