Abstract
Early and adequate coronary reperfusion is the main goal of therapy during acute myocardial infarction. Primary coronary angioplasty is associated with higher rates of reperfusion, but can only be performed in specialized centers. If the patient cannot be referred to a cardiology center for an operation without delay, thrombolysis must be performed as soon as possible, and in case of failure, the patient must be transferred for a rescue angioplasty. New antithrombotics are under investigation: the association of anti-GPIIbIIIa to half doses of thrombolytics improves the rate of recanalisation. Given during angioplasty and stenting, they reduce the rate of early coronary reocclusion. Prevention of the no-reflow phenomenon (inadequate myocardial reperfusion in spite of successful coronary recanalisation) is another promising method. Finally, specific studies are required in diabetic or aged patients, in whom the mortality of acute MI remains high, in spite of all these improvements.
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