Author/Editor		Noč, Marko
Title		Reperfusion strategies in ST-elevation myocardial infarction
Type		članek
Source		In: Štiblar-Martinčič D, Petrovič D, editors. Cardiovascular diseases. Proceedings of the 32nd memorial meeting devoted to professor Janez Plečnik, International symposium in memory of professor Rene Favaloro; 2001 Dec 6-8; Ljubljana. Ljubljana: Medical faculty,
Publication year		2001
Volume		str. 199-204
Language		eng
Abstract		Patients with persistent ST elevation in two or more contiguous leads or with a new onset of bundle branch block have most likely complete thrombotic occlusion of one of the epicardial coronary arteries. Survival of patients with evolving ST elevation myocardial infarction is crucially related to the ability of restoring immediate, complete and sustained patency of the infarct related artery and thereby interrupting the evolving myocardial infarction. Both, pharmacological or mechanical options for recanalization of the infarct related artery are available. Front-loaded tissue plasminogen activator currently represents the "thrombolytic" standard of care. The third generation of thrombolytic agents such as reteplase, tenecteplase and lanoteplase did not demonstrate survivor benefit and main shortcomings of thrombolysis-unsatisfactory rates of epicardial TIMI 3 flow, frequent reocclusion and constant threat of intracranial bleeding, remain. Facilitated thrombolysis with combination of low-dose reteplase and platelet glycoprotein Ilb/llla inhibitor abciximab demonstrated less reinfarction, more bleeding complication and no survival benefit. When carried out by experienced hands in high-volume laboratories using current technology including coronary stents and adjunctive pharmacotherapy with glycoprotein llb/Ila inhibitors, primary angioplasty demonstrated superior epicardial patency in excess of 95%. This was associated with significant reduction in 30-day mortality/reinfarction (7.2% vs. 11.9%) and stroke (0.7% vs. 2.0%) when compared to thrombolysis. Unfortunately, only minority of hospitals have an ability to perform this procedure. (Abstract truncated at 2000 characters).
Descriptors		MYOCARDIAL INFARCTION ELECTROCARDIOGRAPHY MYOCARDIAL REPERFUSION THROMBOLYTIC THERAPY PLATELET GLYCOPROTEIN GPIIB-IIIA COMPLEX ANGIOPLASTY, TRANSLUMINAL, PERCUTANEOUS CORONARY