PMID: 9448906Aug 1, 1997Paper

Interventional management of acute myocardial infarction (AMI)

Australian and New Zealand Journal of Medicine
J H Bett

Abstract

The best way to limit infarct size and improve survival in patients with early heart attacks is to restore as quickly as possible patency in the infarct-related artery and blood flow to the threatened myocardium. The value of thrombolytic therapy and aspirin has been shown in large clinical trials. A regimen of accelerated recombinant tissue plasminogen activator is more effective than those using streptokinase. In older patients, there is a greater risk of haemorrhagic stroke; nevertheless, thrombolytic treatment saves more lives because the mortality of myocardial infarction (MI) is higher. Thrombolytic therapy fails to restore blood flow sufficiently rapidly or completely in nearly one-fifth of patients. Its efficacy, therefore, has been compared with immediate or direct angioplasty (PTCA). If it can be done promptly enough, PTCA is superior in preventing recurrent ischaemia and the combined outcome of death or non-fatal reinfarction, and is associated with a lesser risk of intracranial haemorrhage. It may also be cheaper because patients spend less time in hospital and fewer of them require late revascularisation. PTCA should be considered for patients with cardiogenic shock or for those in whom there is a contraindication ...Continue Reading

References

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Citations

Aug 3, 2005·Microscopy and Microanalysis : the Official Journal of Microscopy Society of America, Microbeam Analysis Society, Microscopical Society of Canada·W Gray JeromeRoy R Hantgan

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