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Reperfusion in acute myocardial infarction.
C J Lavie1, B J Gersh, J H Chesebro
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905.
Mayo Clinic Proceedings
|April 1, 1990
Summary
Early thrombolytic therapy for acute myocardial infarction (AMI) restores artery patency, salvages heart muscle, and reduces mortality. Percutaneous transluminal coronary angioplasty (PTCA) is useful for specific cases, but conservative strategies are recommended for most patients.
Area of Science:
- Cardiology
- Thrombosis Research
- Emergency Medicine
Background:
- The role of thrombosis in acute myocardial infarction (AMI) is widely accepted.
- This has spurred interest in reperfusion therapies, especially thrombolysis.
Purpose of the Study:
- To review the efficacy of thrombolytic therapy in AMI.
- To discuss recommendations for its use, contraindications, and adjunctive therapies.
- To compare thrombolysis with percutaneous transluminal coronary angioplasty (PTCA) strategies.
Main Methods:
- Review of accumulating evidence on thrombolytic therapy in AMI.
- Analysis of current recommendations and treatment strategies.
- Comparison of thrombolytic therapy with PTCA in specific patient subsets.
Main Results:
- Early systemic thrombolytic therapy can restore infarct-related artery patency.
- Thrombolysis effectively salvages myocardium and reduces mortality in AMI.
- PTCA is beneficial for specific AMI cases, such as persistent artery occlusion or cardiogenic shock.
Conclusions:
- A conservative strategy of angiography and PTCA for postinfarction ischemia is indicated for most patients after successful thrombolysis.
- PTCA after failed thrombolysis or as primary therapy shows promise.
- Further research is needed to define optimal reperfusion strategies, time limitations, and methods to limit reperfusion injury.