Reperfusion therapy for acute myocardial infarction. Which strategy for which patient?

Drugs
E BoersmaM Simoons

Abstract

Several modes of reperfusion therapy for evolving myocardial infarction (MI) have been developed, which differ in terms of effectiveness, complexity and costs. Reperfusion resources are often restricted by budgetary or logistical circumstances. To arrive at an equitable distribution of treatment options, physicians should therefore consider which treatment to apply in which patient. Two major questions which arise in this respect are discussed here: what is the treatment effect in an individual patients, and what is an equitable resource allocation? Currently, the most relevant treatment options are: streptokinase (1.5MU over 1h), reteplase (2 boluses of 10MU), alteplase (tissue plasminogen activator; t-PA) [100mg over 1.5 hours] and immediate angioplasty. In combination with aspirin, streptokinase leads to an almost 40% mortality reduction at 1 month compared with placebo [from 13.2 to 8.0%; Second International Study of Infarct Survival (ISIS-2) trial]. The Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO-1) study demonstrated a further mortality reduction by early combination therapy of aspirin, intravenous heparin and alteplase vs aspirin, heparin (either intravenous or subcutaneous) plus s...Continue Reading

Citations

Jul 9, 2002·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·A AsbergH Holdaas
Jun 1, 2004·Seminars in Interventional Radiology·Alexjandro Mendez-CastilloFlavio Castañeda
Sep 13, 2000·Drugs·R T van DomburgM L Simoons
Jun 22, 1999·Lancet·M L SimoonsJ W Deckers
Nov 12, 2013·Indian Heart Journal·Jamshed DalalK A Sambasivam

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