Thrombolysis with tissue plasminogen activator in acute myocardial infarction: no additional benefit from immediate percutaneous coronary angioplasty

A randomised trial of 367 patients with acute myocardial infarction was performed to determine whether an invasive strategy combining thrombolysis with recombinant tissue-type plasminogen activator (rTPA), heparin, and acetylsalicylic acid, and immediate percutaneous transluminal coronary angioplasty (PTCA) would be superior to a noninvasive strategy with the same medical treatment but without immediate angiography and PTCA. Intravenous infusion of 100 mg rTPA was started within 5 h after onset of symptoms (median 156 min). Angiography was performed 6-165 min later in 180 out of 183 patients allocated to the invasive strategy; 184 patients were allocated to the non-invasive strategy. Immediate PTCA reduced the percentage stenosis of the infarc

Ventricular pump function in acute myocardial infarction : invasive hemodynamic assessment and therapeutic implications

Thèse d'agrégation de l'enseignement supérieur (Faculté de médecine) -- UCL, 198

[Update on the pharmacological treatment of unstable angina.]

The combined death/infarct rate in the weeks following unstable angina ranges from 10 to 40 %. Aspirin and GP Ilb/IIIa antagonists reduce the mortality and morbidity, which has not been demonstrated with heparin. The short term clinical results of treatment with hirudin are better than those with heparin. A rebound biological effect after heparin or hirudin therapy may have adverse clinical consequences. Nitrate derivatives have a role to play and adjuvant therapy includes the betablockers and some calcium antagonists in special indications