Should all patients with an acute myocardial infarction be referred for direct PTCA?

All randomised comparisons have shown that direct PTCA is superior to thrombolysis in patients with AMI. Yet the choice of treatment strategy should depend on the careful evaluation of the risk/benefit of treatment. Issues unrelated to this assessment will most likely influence the selection of treatment in daily practice. Two algorithms have been proposed which differ in the primary selection or triage criterion (area at risk versus time interval). Based upon local and regional factors, one or the other may be chosen. The role of rescue and systematic PTCA after thrombolysis needs further elucidation. At present, it cannot be proposed as a standard treatment.

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