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Education in Heart
CORONARY DISEASE
Acute myocardial infarction: primary angioplasty
  1. Felix Zijlstra
  1. Department of Cardiology, Hospital De Weezenlanden, Zwolle, The Netherlands
  1. Dr F Zijlstra, Hospital De Weezenlanden, Department of Cardiology, Groot Wezenland 20, 8011 JW Zwolle, The Netherlandsf.zijlstra{at}diagram-zwolle.nl

https://doi.org/10.1136/heart.85.6.705

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    The treatment of myocardial infarction has evolved considerably over the past decades. Reported mortality rates have fallen as a result of a variety of factors, including earlier diagnosis and treatment of the acute event, improved management of complications such as recurrent ischaemia and heart failure, and general availability of pharmacological treatments such as aspirin, β blockers, and angiotensin converting enzyme inhibitors.1 Most attention, however, has been focused on treatments that may restore antegrade coronary blood flow in the culprit artery of the patient with evolving acute myocardial infarction. The two methods to achieve this goal are thrombolytic treatment and immediate coronary angiography followed by primary angioplasty if appropriate.1

    Key points

    • Restoration of antegrade coronary blood flow in the culprit artery of the patient with evolving acute myocardial infarction is of paramount importance

    • Primary angioplasty can be applied as an alternative reperfusion therapy in candidates for thrombolytic treatment and is the only reperfusion option in all other patients

    • Primary angioplasty results in two lives saved per 100 patients treated compared with thrombolysis

    • Primary angioplasty results in a lower risk of stroke and reinfarction compared with thrombolysis

    • The higher the risk of the patient, the greater the potential of primary angioplasty compared with thrombolysis

    History of angioplasty for acute myocardial infarction

    Angioplasty for acute myocardial infarction was first described as a rescue treatment in the case of failed intracoronary thrombolysis, and was studied extensively as adjunctive therapy, performed immediately (within hours), early (within 1–2 days), late (after two days), or elective for inducible ischaemia and/or postinfarction angina, after intravenous thrombolytic treatment. Primary angioplasty, without the use of thrombolytic treatment, was described in 1983.2 It can be applied as an alternative reperfusion therapy in candidates for thrombolytic treatment, and is the only reperfusion option in many patients with acute myocardial infarction ineligible for thrombolytic treatment.

    Pathophysiological considerations and concomitant pharmacological treatment

    Studies based …

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