The Restoration of Coronary Blood Flow in Acute Myocardial Infarction

When an acute coronary syndrome degenerates into a myocardial infarction the centerpiece of therapy is the normalization of myocardial blood flow to the extent that it can be achieved in the shortest interval possible after the onset of symptoms. A variety of strategies including mechanical intervention have been used to achieve this goal, but the benchmark therapy to which all other therapeutic alternatives must be compared involves the use of thrombolytic agents. However, given the availability of catheter laboratories and interventional expertise, mechanical reperfusion appears to be at least as good and probably better than thrombolytic therapy. Because of the universal access to thrombolytic therapy, certain clinical issues must be underscored. More important than pursuing the ideal thrombolytic agent is the administration of thrombolytic therapy at the earliest possible juncture after the onset of symptoms heralding myocardial infarction. Adjunctive therapy includes aspirin and intravenous heparin. Altering platelet activity by glycoprotein IIb/IIIa receptor blockers holds enormous promise for thrombolytic therapy and PTCA, but as yet enjoys limited availability on a global scale.