Percutaneous transluminal coronary angioplasty in acute myocardial infarction without prior thrombolytic therapy

In most patients transmural acute myocardial infarction (AMI) is caused by acute coronary artery occlusion consisting of an atherosclerotic plaque with superimposed thrombus.¹ One of the most notable of the recent therapeutic advances for AMI is the use of intracoronary streptokinase, which results in restoration of coronary flow in 64 to 85% of patients.^2,3 Disadvantages of this technique include both subsequent hemostatic problems and frequently severe residual stenosis that may jeopardize any expected wall motion improvement.⁴ Percutaneous transluminal coronary angioplasty (PTCA) has recently been used immediately after successful coronary thrombolysis to dilate severe residual stenoses.⁵ Some investigators feel that such an approach leads to greater wall motion recovery and lessens the risks of reocclusion.^4,5 Even more recently, PTCA has been proposed as the initial therapy in AMI because it avoids hemostatic problems and long infusion times involved with thrombolytic therapy.⁶ We report our experience with PTCA without prior thrombolytic therapy in the management of patients with AMI as an alternative to thrombolytic therapy.