[What strategy for treating the acute phase of myocardial infarction?]

Therapeutic strategy of treatment of the acute phase of myocardial infarction has been considerably modified the last few years by the administration of drugs which protect the ischemic myocardium (beta-blockers, calcium-channel inhibitors, notably), or in preventing development of necrosis by reperfusing it either by coronary bypass procedures, or by intracoronary thrombolysis or coronary angioplasty. But these methods are difficult to institute rapidly. Thus, we prefer to perform intravenous thrombolysis, which now may even be given in the patient's home. Clinical experience obtained by the SAMU medical emergency unit in Marseille, France shows the feasibility of such an approach. Initial results are satisfactory. The question of coronary angioplasty as a supplementary procedure may then be discussed: which patients are candidates for this method and when should it be performed?