Reperfusion treatment has become standard during acute myocardial infarction over the last several years. Previous studies have shown that an acute occlusion of the coronary artery due to thrombus formation can be recanalized by thrombolytic agents. Currently, intravenous thrombolytic therapy is widely used. Streptokinase, tPA and, on some occasions, urokinase, have been used for this purpose. tPA has been shown to be particularly effective in achieving reperfusion in approximately 75 per cent of patients. One of the major hazards to using thrombolytic therapy is serious intracranial or internal bleeding complications. Although such complications are relatively infrequent, patients must be carefully screened to exclude those with contraindications when thrombolytic therapy is considered. The alternative method to achieve reperfusion is PTCA. PTCA has been shown to be an effective method of establishing reperfusion during acute myocardial infarction and decreasing residual stenosis. In patients who fail to respond to thrombolytic therapy or those with contraindications to such therapy, PTCA should be considered as the alternative method to achieve reperfusion. Many studies have demonstrated significant salvage of myocardium by reperfusion therapy and recovery of left ventricular function in the infarct segment. In addition, recent randomized studies have clearly demonstrated beneficial effects on prognosis following thrombolytic therapy. In-hospital mortality as well as long-term mortality were remarkably reduced with intravenous thrombolytic therapy. Reperfusion by either thrombolytic therapy or PTCA should be considered during acute myocardial infarction to salvage the left ventricle and improve prognosis.
|Original language||English (US)|
|Number of pages||19|
|Journal||Anesthesiology Clinics of North America|
|State||Published - Jan 1 1988|
ASJC Scopus subject areas
- Anesthesiology and Pain Medicine