[Reperfusion therapy in acute myocardial infarction today: thrombolysis, balloon angioplasty and stenting].

Prompt restoration of coronary flow is the principal mechanism by which reperfusion therapy improves survival and other clinical outcomes in patients with acute myocardial infarction. Thrombolytic therapy has been the standard for care over the past decade. The use of accelerated administration of tissue plasminogen activator (t-PA) and modified or mutant t-PA which can be administered with a single bolus intravenous injection might bring further benefits. Primary balloon angioplasty (percutaneous transluminal coronary angioplasty: PTCA) is safe and effective when it can be performed quickly by experienced operators, resulting in better coronary flow and short-term survival rates than are obtained with thrombolytic therapy. However, several studies reporting data from more than 5,000 patients, of whom many were treated in low-volume local hospitals showed mortality with primary angioplasty was substantially higher than that reported from high-volume medical centers, and similar to that observed with thrombolysis with accelerated t-PA. The strategy of rapid administration of thrombolytic therapy and subsequent angioplasty only for recurrent ischemia seems to be as effective as primary angioplasty. Recently several reports have indicated that coronary stenting, when performed for suitable lesions and with good technique by experienced operators, is superior to the results obtained with balloon angioplasty and thrombolysis. However, further studies are required to establish the efficacy of primary stenting compared to PTCA.