ACUTE MYOCARDIAL-INFARCTION - REPERFUSION STRATEGIES

Acute myocardial infarction is the result of an acute interruption of myocardial blood flow resulting in ischemic myocardial necrosis. The p athogenesis of this phenomenon nearly always involves acute thrombosis superimposed on a disrupted atherosclerotic plaque. Thrombolytic agen ts have been conclusively shown to reduce mortality in many patient su bgroups with myocardial infarction, including the elderly, patients wi th inferior myocardial infarction, and patients with systolic hyperten sion. Nearly all patients with acute myocardial infarction of less tha n 6 h in duration with S-T segment elevation should receive thrombolys is unless significant contraindications exist and outweigh the potenti al benefits. Aspirin should be given to almost all patients regardless of whether they receive thrombolysis. Angioplasty and coronary artery bypass surgery are useful as primary or secondary modes of reperfusio n in selected patients with infarction.