Emerging role of PTCA in acute MI
Five different strategies have been devised for the use of percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction (MI): direct (or primary), immediate, rescue (or salvage), deferred, and elective (also known as 'watchful waiting'). Although data from three randomized, controlled comparative trials suggest that direct PTCA may be associated with better outcomes than thrombolysis, these data should be interpreted cautiously. Immediate PTCA has been shown to be no better and perhaps more harmful than thrombolysis alone. Rescue PTCA may be an attractive treatment option for patients in whom thrombolysis fails or who experience reocclusion after successful thrombolysis. The strategy of performing angiography early to locate critical stenoses but deferring intervention until after a 'cooling-off' period is safe and effective. A watchful waiting approach has been shown to achieve equivalent results in terms of mortality and reinfarction when compared with deferred PTCA.
Harrington, RA; Califf, RM
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