Revista Colombiana de Cardiología
Print version ISSN 0120-5633
Treatment of acute myocardial infarction has evolutioned during the last two decades from a passive attitude to a more aggressive one. Since the publication of the first articles showing the benefits of an early myocardic reperfusion, there has been a constant concern in order to find better drugs and better techniques that may allow the opening of the implicated artery with the best percentage of success in an each time more rapid way. Advent of primary PTCA allowed having a mechanical alternative that could not only open the implicated vessel, but permitted also a rapid evaluation of post-opening flow and a precise determination of the whole coronary anatomy. Nevertheless, immediately there were questionings in regard to the dependence of complex technological resources and the operability by expert interventionists. Recently, a metanalisis that evaluated 23 aleatory studies reported a superiority of primary PTCA over thrombolysis, in regard to death, re-infarction and stroke. However its applicability on a large scale remained without being solved. In order to demonstrate that an interventionist strategy for all patients with acute myocardial infarction could be recommended, several assays comparing thrombolisis in situ versus the possibility of realizing primary PTCA in hospitals, were performed. These studies demonstrated PA superiority only in re-infarction. Besides, an assay versus pre-hospitalization thrombolysis demonstrated an advantage of this last one. In conclusion, in spite of the cold ciphers, it is not clear that a strategy for each patient with acute myocardial infarction may be generalized. It may be more intelligent to create algorhythms based on availability of competent homodynamic laboratories, inherent risks of acute myocardial infarction, inherent risk of transportation, and initiation of symptoms. In our countries, the possibility of pre-hospitalization thrombolysis should be explored.
Keywords : acute myocardial infarction; thrombolysis; primary PTCA; ischemic cardiopathy.