[Pharmacologic combination in the treatment of the acute myocardial infarction with ST elevation]

The evolution of reperfusion treatment has permitted an improvement in the prognosis and survival of patients with Acute myocardial infarction with ST elevation. The benefit of thrombolitic therapy was demonstrated clearly starting with the first trials of ISIS 2. It was also demonstrated this benefit is greater when the thrombolitic is combined with aspirin. Other trials have arisen like GUSTO I and TIMI 14, which have continued with the search for the best strategy of reperfusion, demonstrating that the pharmacologic combination with fibrinolitic, antiplatelet and antithrombinics provides the best results regarding permeability of the epicardic artery and transmiocardic reperfusion. Finally the mechanical reperfusion has managed to improve the results obtained with the pharmacologic treatment. Nevertheless it is probably that the Angioplasty with fibrinolitic and antiplatelet therapy is a useful treatment strategy, available for the patient with acute coronary syndrome with ST elevation. In light of the latest studies we must be very cautious, but based on the knowledge of the physiopathology of these syndromes, we think there is still much to discover.