Invasive cardiac procedures after myocardial infarction: which procedure when and its relationship to thrombolysis

The availability and the now routine use of thrombolytic agents are important advances for therapeutic cardiology and the emergency care of patients experiencing AMI. The progression from ischemia to necrosis of cardiac muscle now can be aborted in a portion of this population by initiating thrombolytic infusions. Early use of thrombolysis in these patients has reduced acute myocardial infarction mortality and morbidity significantly. Although thrombolytic therapy has changed the course of treatment and survival after AMI, there may be time when this approach is contraindicated or unsuccessful. Alternative treatments that may be considered when thrombolytic agents cannot be given, or fail to ameliorate ischemia, are emergent percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery. Future interventional procedures such as intracoronary stents, atherectomy devices, and lasers may be considered as emergent treatment in the near future. It is important to have reviewed when these alternative invasive procedures, some of which are currently experimental, might be considered. Indeed, interventional procedures such as intracoronary stents, atherectomy devices, and laser delivery systems eventually may be accepted as primary therapies for the patient who arrives in the emergency department with an AMI. In the meantime, thrombolytic therapy administered as urgently as possible to appropriate patients with myocardial infarction is the most important goal.