Acute Myocardial Infarction: Selection of Reperfusion Strategies in the Individual Patient

The selection of the reperfusion therapy (thrombolysis, PTCA, or no reperfusion) in acute myocardial infarction should depend on the risk-benefit ratio, the availability, and the costs. Thrombolysis is available everywhere and is the standard of reperfusion therapy, but carries the risk of intracranial haemorrhage. PTCA is more effective with less risk, but it is also more expensive and available only in specialised centres. In current clinical practise in Germany, the only important determinant for using PTCA as a reperfusion strategy is the availability of a catheter laboratory. Besides availability, the selection of reperfusion therapy should be made more on clinical relevance: (i) PTCA especially in patients with a large benefit, the presence of contraindications to thrombolysis, or in cardiogenic shock, and (ii) thrombolysis, if PTCA is not immediately available.