A Clinical Evaluation of Primary Angioplasty and Stenting in Acute Myocardial Infarction

In 1949 the fibrinolytic effect of streptococcal fibrinolysin (streptokinase) was described for the treatment of fibrous, pUl1llent or sanguineous pleural exudations. The effect of this lytic agent in patients with acute myocardial infarction was described by Fletcher in 1958. In the late nineteensevcnties the pathofysiologic mechanism underlying acute myocardial infarction was recognised. In the majority of patients with acute myocardial infarction a completely occluded coronary artery is present at immediate angiography, caused by the formation of a platelet rich thrombus on reptured atherosclerotic plaque. Reperfusion therapy is aimed at removal of this obstructing clot which can be achieved by t1uombolytic agents (given directly into the coronary artery or intravenously) or by mechanical intervention (Percutaneous Transluminal Coronary Angioplasty (PTCA)) or by a combination of these two. Rentrop et aJ. described his experience with intracoronary administration of streptokinase in 1979. In 1983 it was shown in small trials that the intracoronary administration of streptokinase was beneficial compared to placebo treatment and later, larger randomised trials demonstrated convincingly that intravenous fibrinolytic therapy re·establishes coronaty patency, thereby limiting infarct size and preserving left ventricular function resulting in improved survival. In 1982, Meyer reported a case in which he successfully re-opened an infarct related vessel with a guide wire and a balloon after failed thrombolytic therapy. One year later Hartzler was the first to describe his experience with primary coronary angioplasty (mechanical revascularization without antecedent thrombolysis).

• View at Worldcat

Free Full Text ( Final Version , 5mb )