Cor Vasa 2002, 43(6):285-290

Current status of acute myocardial infarction therapy: coronary angioplasty, stents, and pharmacotherapy-anything to open artery and microcirculation

Michael Aschermann^1,*, Jan Horák¹, Aleš Linhart¹, Ondřej Aschermann²

¹ II. interní klinika Všeobecné fakultní nemocnice a 1. lékařské fakulty Univerzity Karlovy

² Nemocnice Na Homolce, Praha, Česká republika

Rapid restoration of full coronary flow in the epicardial coronary artery and in myocardial microcirculation is the main goal of therapy of acute myocardial infarction. Fibrinolytic therapy is current standard to achieve this goal, with significant improvement of survival as shown by many randomized trials. Direct coronary angioplasty has several advantages over fibrinolysis, as well as several drawbacks. A combination of fibrinolysis with platelet glycoprotein IIb/IIIa receptor inhibitors showed promising results in clinical trials. Clot lysis was faster, improvement in coronary flow greater than either therapy alone. Several randomized trials have tested a combination of fibrinolysis with subsequent early angioplasty, plus concomitant administration of abciximab. Epicardial blood flow as well as myocardial perfusion at the microvascular level (evaluated by ST segment resolutions) was better, without a significant increase in major bleeding complications. The role of low-weight molecular heparins in combination with fibrinolytics and IIb/IIIa receptor inhibitors is currently being evaluated in ongoing clinical trials. The concept of facilitated coronary angioplasty with fibrinolytics and antiplatelet therapy before intervention will be tested in future trials.

Keywords: Acute myocardial infarction; Pharmacotherapy; Coronary intervention; IIb, IIIa platelet inhibitors

Published: June 1, 2002  Show citation