Emergency primary coronary angioplasty in patients with acute myocardial infarction who are unsuitable for intravenous thrombolysis.

Intravenous thrombolytic therapy is now accepted as the standard method of achieving coronary reperfusion in patients with acute myocardial infarction. There are several important limitations. Primary percutaneous transluminal coronary angioplasty is an attractive method for reopening occluded coronary arteries. Between 1986 and 1993, 14 patients in whom there was an absolute contraindication to thrombolysis underwent emergency coronary angioplasty as the primary treatment for acute myocardial infarction. Coronary artery patency was restored in 13/14 (93%). One patient died in hospital. The median follow-up was one year. One patient suffered a further myocardial infarction and one patient required coronary artery bypass surgery at follow-up. Emergency coronary angioplasty services should be developed to treat those patients in whom there is a contraindication to thromboloysis.