INTRAAORTIC BALLOON PUMPING AS ADJUNCTIVE THERAPY TO RESCUE CORONARY ANGIOPLASTY AFTER FAILED THROMBOLYSIS IN ANTERIOR WALL ACUTE MYOCARDIAL-INFARCTION

Although thrombolytic therapy is widely used to restore antegrade coro nary blood flow, greater than or equal to 25% of the infarct-related c oronary arteries fail to recanalize after thrombolytic therapy.(1) Res cue coronary angioplasty achieves coronary artery patency in a large p roportion of patients in whom coronary thrombolysis has failed, but it is associated with a high reocclusion rate and recovery of left ventr icular function is minimal.(2,3) The left anterior descending coronary artery supplies the largest amount of the ventricular myocardium, and anterior myocardial infarction is associated with a higher mortality rate than myocardial infarction in different locations. Aggressive for ms of management of patients with anterior myocardial infarction have been advocated. Intraaortic balloon pumping is the most reliable metho d for simultaneously increasing diastolic arterial pressure, while red ucing left ventricular load. Intraaortic balloon pumping, if performed after rescue coronary angioplasty, might prevent reocclusion of the c oronary artery through augmentation of coronary perfusion and enhance recovery of left ventricular function through left ventricular unloadi ng.(4,5) To test this hypothesis, we performed intraaortic balloon pum ping in patients with acute anterior myocardial infarction who underwe nt rescue coronary angioplasty after unsuccessful thrombolysis.