[Importance of acute PTCA in the treatment of perioperative myocardial infarction]

Abstract

The mortality of perioperative myocardial infarction is still high and according to recently published data amounts to 17 to 42%. In the seventies introduction of thrombolytic therapy has led to a dramatic reduction in mortality of non-perioperative myocardial infarction. However, in the perioperative situation thrombolytic therapy remains to be problematic in most cases because of expected severe bleeding complications. In the last 4-6 years acute-PTCA has been established in the therapy of acute myocardial infarction. Up to date no data are available concerning the effect of acute-PTCA on mortality of perioperative myocardial infarction. Nevertheless it can be assumed, that acute-PTCA will lead to a considerable reduction in mortality of perioperative myocardial infarction. Therefore, in patients with significant perioperative myocardial infarction immediate coronary angiography and, if indicated, acute-PTCA should be performed. In principle, thrombolytic therapy is considered to be contraindicated in the intra- or postoperative situation. However, if coronary angiography and PTCA are not possible, thrombolysis might be taken into consideration, in particular if the expected bleeding complications are small in relation to the expected benefit of thrombolysis. Since acute-PTCA has been shown to remarkably reduce mortality in patients with cardiogenic shock after acute myocardial infarction, this group of patients should be especially considered.