Thrombolysis and mechanical intervention following myocardial infarction

In concept, mechanical interventions are attractive options for treating acute myocardial infarction with or without preceding thrombolysis: rapid reperfusion of the infarct-related artery can be achieved in the vast majority of cases, and the underlying coronary lesion is treated at the same time. Various strategies have been extensively investigated. When performed in specialized centres, direct percutaneous transluminal coronary angioplasty (PTCA) without prior thrombolysis appears to improve the outcome more than conventional thrombolysis. Whether this also holds true for the diverse range of hospitals remains unknown. Routine PTCA after thrombolysis did not show any benefit over thrombolysis alone. Rescue PTCA after failed thrombolysis is probably beneficial. Currently, only limited experience exists with other mechanical interventions, including intra-aortic balloon pumping, thrombectomy with special new devices, or stent insertion, which need further investigation before they can be recommended for routine use in acute myocardial infarction.