[The treatment of ischemia in acute myocardial infarction]

Abstract

Rapid reestablishment of myocardial blood supply is the ideal in the treatment of acute myocardial infarction. Thrombolysis and, in selected cases, percutaneous transluminal coronary angioplasty (PTCA) or coronary bypass surgery may limit the extent of myocardial necrosis and improve survival. An open, infarct-related artery after thrombolysis carries a better prognosis, but it remains to be established whether the persistent lesion needs to be treated by PCTA or surgery in all patients. Early intravenous beta blockade reduces inhospital mortality by approximately 15% in patients without thrombolysis, while calcium antagonists, despite their theoretical promise and in vitro results, are not effective in the early phase of acute myocardial infarction. Only diltiazem seems to reduce the incidence of reinfarction in patients with non-Q-wave infarction. Aspirin reduces mortality in patients with unstable angina pectoris and in patients with acute myocardial infarction with or without concomitant thrombolysis.