[Intracoronary interventions in the early infarct period]

Despite that intravenous thrombolysis can be regarded as the routine treatment of acute myocardial infarction, alternative or additive interventional procedures in some situations may be well indicated. Primary dilatation without preceding thrombolysis, introduced by G. Hartzler, has shown significantly better results in mortality, re-infarction rate, reduction of coronary stenoses, and improvement of ejection fraction compared to thrombolysis in several randomized studies. The procedure, however, is based on expensive logistics and very experienced operators. In patients with evident failure of lysis, large infarctions, depressed left ventricular function, and cardiogenic shock, rescue-PTCA is indicated. If it is performed early this intervention shows good acute and late results. The elective dilatation of residual stenoses after successfull thrombolysis is performed only in selected cases. Its main indication is proven ischemia within the first days and weeks after onset of infarction. Early cardiac surgery is performed in patients with cardiogenic shock, papillary or septum rupture, and with cardiac tamponade. Good results can also be expected in main stem stenoses and severe multivessel diseases. The optimal time of surgery, however, is still controversial. The Task Force of the International Society and Federation of Cardiology (IFSC) and the World Health Organization (WHO) has worked out recommendations for intracoronary maneuvers in various situations of the acute phase of myocardial infarction. With thoughtful consideration of indications these additional procedures in the hands of experienced teams play an important role in the acute treatment of this severe disease.