Coronary Angioplasty in Acute Myocardial Infarction: Primary, Immediate Adjunctive, Rescue, or Deferred Adjunctive Approach? ROBERT D. SIMARI, M.D.,

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Presentation transcript:

Coronary Angioplasty in Acute Myocardial Infarction: Primary, Immediate Adjunctive, Rescue, or Deferred Adjunctive Approach? ROBERT D. SIMARI, M.D., PETER B. BERGER, M.D., MALCOLM R. BELL, M.B.,B.S., RAYMOND J. GIBBONS, M.D., DAVID R. HOLMES, M.D. Mayo Clinic Proceedings Volume 69, Issue 4, Pages 346-358 (April 1994) DOI: 10.1016/S0025-6196(12)62220-4 Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 1 Strategies for coronary angioplasty in acute myocardial infarction. PTCA = percutaneous transluminal coronary angioplasty; ST = ST segment. Mayo Clinic Proceedings 1994 69, 346-358DOI: (10.1016/S0025-6196(12)62220-4) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 2 Left ventricular ejection fraction in randomized trials of coronary angioplasty versus thrombolysis in acute myocardial infarction. A, At dismissal. B, At 6 weeks after infarction. PAMI = Primary Angioplasty in Myocardial Infarction; PTCA = percutaneous transluminal coronary angioplasty. Mayo Clinic Proceedings 1994 69, 346-358DOI: (10.1016/S0025-6196(12)62220-4) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 3 Left ventricular function in immediate and conservative therapy groups in three trials of thrombolysis and coronary angioplasty: Thrombolysis and Angioplasty in Myocardial Infarction (TAMI I), Thrombolysis in Myocardial Infarction (TIMI II A), and European Cooperative Study Group (ECSG). Mayo Clinic Proceedings 1994 69, 346-358DOI: (10.1016/S0025-6196(12)62220-4) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 4 Mortality in immediate and conservative groups in three trials of thrombolysis and coronary angioplasty: Thrombolysis and Angioplasty in Myocardial Infarction (TAMI I). Thrombolysis in Myocardial Infarction (TIMI II A), and European Cooperative Study Group (ESCG). Mayo Clinic Proceedings 1994 69, 346-358DOI: (10.1016/S0025-6196(12)62220-4) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions

Fig. 5 Photomicrographs of cross sections from left anterior descending artery of 74-year-old woman with acute anterior myocardial infarction who underwent intracoronary administration of streptokinase and immediate angioplasty. A, At level of angioplasty procedure, intimal tear (along left side of artery) led to adjacent intramedial dissection and focal adventitial hemorrhage. B, Extension of intramedial dissection tract led to formation of large hematoma (at top of artery) and subsequent severe extrinsic luminal compression (at bottom of artery), distal to site of balloon dilation. (Hematomxylin-eosin; A, X20; B, x50.) (Photograph courtesy of Dr. William D. Edwards, Division of Anatomic Pathology, Mayo Clinic.) Mayo Clinic Proceedings 1994 69, 346-358DOI: (10.1016/S0025-6196(12)62220-4) Copyright © 1994 Mayo Foundation for Medical Education and Research Terms and Conditions