Acute Myocardial Infarction

Reperfusion Strategies

¹ From the Center for Lung Research, Division of Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tenn.

Acute myocardial infarction is the result of an acute interruption of myocardial blood flow resulting in ischemic myocardial necrosis. The pathogenesis of this phenomenon nearly always involves acute thrombosis superimposed on a disrupted atherosclerotic plaque. Thrombolytic agents have been conclusively shown to reduce mortality in many patient subgroups with myocardial infarction, including the elderly, patients with inferior myocardial infarction, and patients with systolic hypertension. Nearly all patients with acute myocardial infarction of less than 6 h in duration with S-T segment elevation should receive thrombolysis unless significant contraindications exist and outweigh the potential benefits. Aspirin should be given to almost all patients regardless of whether they receive thrombolysis. Angioplasty and coronary artery bypass surgery are useful as primary or secondary modes of reperfusion in selected patients with infarction.

Key Words: acute myocardial infarction • aspirin • CABG • coronary ischemia • heparin • PCTA • reperfusion