PMID: 7939519Sep 3, 1994Paper

Direct coronary angioplasty in acute myocardial infarct

Schweizerische medizinische Wochenschrift
B Meier

Abstract

Direct (primary) coronary angioplasty for acute myocardial infarction has appeared in the literature since 1982, first as a rescue therapy in case of failed intracoronary thrombolysis, then as its complement, and finally as an alternative. In the late eighties, the upsurge of intravenous thrombolysis turned the focus off direct angioplasty until several randomized studies demonstrated the superiority of angioplasty in 1993. For an infarction primarily due to a thrombus, it is the treatment of choice. However, there is no accurate way to predict these lesions. Direct angioplasty yields results comparable with the best published results of thrombolysis. However, the patients included in the thrombolysis studies usually present less severe clinical pictures than those undergoing angioplasty. On the average, direct angioplasty is successful in 90%, reocclusion occurs in 11%, and emergency bypass surgery becomes necessary in 3%. Hospital mortality is 7%. The risk factors known from thrombolysis also apply to direct angioplasty, such as multivessel disease, old age, cardiogenic shock and duration of infarction. Failed angioplasty is also a harbinger of death. In randomized comparisons with thrombolysis, an initial 30-45 minutes delay...Continue Reading

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