Evolving concepts in the treatment of acute myocardial infarction.

R. A. Lange, L. D. Hillis

Research output: Contribution to journalArticle

Abstract

Recent studies in patients with transmural acute myocardial infarction have demonstrated that intravenous thrombolytic therapy with streptokinase or tissue plasminogen activator improves left ventricular function and reduces mortality. To accomplish this, these agents must be infused early, ie, within 3 to 4 hours of the onset of chest pain; later administration of the agents exerts no significant beneficial effect. Tissue plasminogen activator appears to be the most effective and safest of the available thrombolytic agents: its intravenous administration is followed by coronary reperfusion in about 70% of patients, and its use is not associated with allergic reactions, a systemic fibrinolytic state, or a prolonged fibrinolytic effect. Once reperfusion has been established with an intravenous thrombolytic agent, intravenous heparin is given for several days, followed by oral aspirin to prevent reocclusion. Since many of these patients have a residual high-grade coronary artery stenosis in the infarct-related artery, mechanical alleviation of the residual stenosis with angioplasty or bypass surgery is an attractive therapy 2 to 4 days after reperfusion, and preliminary data indicate that elective coronary angioplasty 3 days after thrombolytic therapy is beneficial. However, further studies are needed to assess more definitively the use of such an aggressive therapeutic strategy.

Original languageEnglish (US)
Pages (from-to)143-152
Number of pages10
JournalAmerican Journal of the Medical Sciences
Volume296
Issue number2
StatePublished - Aug 1988
Externally publishedYes

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Fibrinolytic Agents
Thrombolytic Therapy
Myocardial Infarction
Tissue Plasminogen Activator
Angioplasty
Reperfusion
Myocardial Reperfusion
Streptokinase
Coronary Stenosis
Chest Pain
Left Ventricular Function
Intravenous Administration
Aspirin
Heparin
Hypersensitivity
Pathologic Constriction
Therapeutics
Arteries
Mortality

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Evolving concepts in the treatment of acute myocardial infarction. / Lange, R. A.; Hillis, L. D.

In: American Journal of the Medical Sciences, Vol. 296, No. 2, 08.1988, p. 143-152.

Research output: Contribution to journalArticle

Lange, R. A. ; Hillis, L. D. / Evolving concepts in the treatment of acute myocardial infarction. In: American Journal of the Medical Sciences. 1988 ; Vol. 296, No. 2. pp. 143-152.
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