Update on mechanical revascularization in acute myocardial infarction: which role and when?

Mechanical revascularization in the acute myocardial infarction by primary angioplasty has several advantages over thrombolytic therapy. The short-ter m patency rates of the infarct-related artery range from 95 to 99% and a no rmal flow is achieved in more than 90% of the cases. This prompt and effect ive reperfusion is probably responsible for the improved prognosis with pri mary angioplasty. The better outcome after primary angioplasty is observed both in low- and in high-risk patients, in all ages and in patients present ing late (>6 h) after the chest pain. Pooled analysis of randomized studies , show that primary angioplasty as compared to thrombolysis, has a lower in cidence of death, stroke and reinfarction. Additional advantages of primary PTCA include the possibility of reperfusion in patients in whom lysis is c ontraindicated or less effective (e.g. patients in cardiogenic shock, or wi th prior coronary artery bypass surgery) and the ability to provide prognos tic information helpful in the patient triage. Thus, primary PTCA results i n better outcome than thrombolysis when performed in centers with success r ates comparable to those achieved in the randomized trials. Further studies are still needed to assess its long-term efficacy. Several randomized tria ls are underway to assess the role of stents and the use of more potent ant iplatelet drugs, as the GPIIb/IIIa receptor blockers, in adjunct to balloon angioplasty in the treatment of acute myocardial infarction. (C) 1999 Else vier Science Ireland Ltd. All rights reserved.