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Acute myocardial infarction: bring the treatment to the patient
  1. Thoraxcentre, University Hospital Dijkzigt
  2. Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands

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In the early 1980s it was determined that a myocardial infarction is usually caused by an acute thrombotic obstruction of a coronary artery. Since that time various pharmacological and mechanical treatment strategies have been developed that aim at rapid, complete, and persistent reperfusion of intracoronary blood flow. In general, these reperfusion strategies contributed considerably to improving the patient’s prognosis, both short and long term.1-5 There are, however, differences in clinical effectiveness between several treatment strategies, and the combined evidence of randomised clinical trials is favourable for primary percutaneous transluminal coronary angioplasty (PTCA) compared with administration of a thrombolytic agent.2 This, however, does not imply that the mechanical approach should be the strategy of choice in all circumstances.

Experimental studies demonstrated that necrosis of viable myocardial tissue mainly happens during the 30 to 90 minutes following coronary occlusion. Consequently, …

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