Document Detail

Thrombolysis and percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction.
MedLine Citation:
PMID:  10810775     Owner:  NLM     Status:  MEDLINE    
Acute myocardial infarction (AMI) remains a leading cause of morbidity and mortality in the developed countries. Thrombotic occlusion of a coronary artery has been shown to cause acute myocardial infarction in over 90% of the cases. Early and complete restoration of bloodflow in the infarct-related coronary artery is the principal mechanism by which reperfusion therapy improves outcomes in patients with acute myocardial infarction. Thrombolytic therapy has been shown to reduce mortality when given early after symptom onset. However, even the most effective, approved thrombolytic regimens achieve normal (so-called TIMI 3) flow in the infarct vessel at 60-90 minutes only in about half of the patients and reocclusion occurs in 5-10%. Bleeding events, especially intracranial bleedings, observed in up to 1% of the patients, are the most severe complication of thrombolysis. Primary percutaneous transluminal coronary angioplasty (PTCA) is associated with somewhat higher patency rates and significantly fewer strokes than thrombolysis, but confers a reocclusion rate of about 5-10% and it is not universally available. While smaller randomized studies suggested a significant advantage of PTCA over thrombolysis, these results could not be confirmed in the larger GUSTO IIb angioplasty study in over 1000 patients and in non-randomized comparisons in large registries. Therefore, a general mortality advantage of PTCA over thrombolysis could not be demonstrated. Primary PTCA should be preferred in patients with contraindications against thrombolysis, patients with a high risk for intracranial bleedings (age > 75 and high blood pressure on admission) and hemodynamically unstable patients. There are several approaches to improve outcome of patients with acute myocardial infarction: new fibrinolytic agents may improve early infarct related patency, single bolus administration of thrombolytics may reduce time-to-treatment, stent implantation may improve direct PTCA, enhanced thrombin and platelet inhibition may facilitate both, thrombolysis and primary PTCA, enhance reperfusion on the cellular level and reduce reocclusions and ultimately improve prognosis of patients with acute myocardial infarction.
U Zeymer; K L Neuhaus
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Publication Detail:
Type:  Comparative Study; Journal Article; Review    
Journal Detail:
Title:  Zeitschrift für Kardiologie     Volume:  89 Suppl 4     ISSN:  0300-5860     ISO Abbreviation:  Z Kardiol     Publication Date:  2000  
Date Detail:
Created Date:  2000-06-02     Completed Date:  2000-06-02     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0360430     Medline TA:  Z Kardiol     Country:  GERMANY    
Other Details:
Languages:  eng     Pagination:  IV30-40     Citation Subset:  IM    
Klinikum Kassel Medizinische Klinik II, Germany.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary* / adverse effects
Antithrombins / therapeutic use
Aspirin / therapeutic use
Cerebral Hemorrhage / etiology
Clinical Trials, Phase II as Topic
Enzyme Precursors / therapeutic use
Fibrinolytic Agents / therapeutic use
Hirudin Therapy
Myocardial Infarction / mortality,  therapy*
Myocardial Reperfusion
Platelet Aggregation Inhibitors / therapeutic use
Randomized Controlled Trials as Topic
Recombinant Proteins / therapeutic use
Stroke / etiology
Thrombolytic Therapy* / adverse effects,  methods
Time Factors
Tissue Plasminogen Activator / therapeutic use
Urokinase-Type Plasminogen Activator / therapeutic use
Reg. No./Substance:
0/Antithrombins; 0/Enzyme Precursors; 0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 0/Recombinant Proteins; 133652-38-7/reteplase; 153484-31-2/SUN 9216; 50-78-2/Aspirin; 99149-95-8/saruplase; EC 3.4.21.-/TNK-tissue plasminogen activator; EC Plasminogen Activator; EC Plasminogen Activator

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