A rationale for the use of percutaneous transluminal angioplasty in the setting of acute myocardial infarction.

Rapid reperfusion of infarcting myocardium has become a cornerstone of modern medical care. The role of percutaneous transluminal coronary angioplasty (PTCA) in this treatment of acute myocardial infarction is not clear. PTCA is effective in the early hours of MI as primary reperfusion therapy, in lieu of thrombolysis. Arterial patency using this strategy is excellent with low complication rates, and this therapy is comparable and may be superior to thrombolysis when myocardial performance and recurrent ischemia are considered. PTCA is the treatment of choice for the patient in whom thrombolysis is contraindicated, or who develops cardiogenic shock. The role of angioplasty as secondary therapy for myocardial infarction after pharmacologic thrombolysis and reperfusion is controversial. The evidence is clear that immediate PTCA after successful thrombolysis is not warranted. The decision for elective angioplasty after successful or unsuccessful thrombolysis should probably be judged on a case to case basis.