THERAPY OF ACUTE MYOCARDIAL-INFARCTION - LYSIS OR PTCA

Duration and extent of myocardial ischemia are the main determinants o f myocardial infarction size and mortality. Therefore, the aim of ther apy has to be reduction of extent and duration of myocardial ischemia. Hence, time of reopening of the infarct related coronary artery is cr itical. At present, systemic thrombolysis is therapy of choice in acut e myocardial infarction as it can be done everywhere immediately. The best results regarding reduction of infarct mortality can be obtained by a thrombolytic therapy using the recombinant tissue type plasminoge n activator (rt-PA). If a cardiac catheterization laboratory is availa ble, immediate percutaneous transluminal catheter angioplasty (PTCA) c an be performed as well leading to similar beneficial results. In addi tion, patients after preceding unsuccessful systemic thrombolytic ther apy or those suffering from cardiogenic shock due to myocardial infarc tion have benefit from immediate mechanical recanalization of the occl uded coronary artery by PTCA.