Should Thrombolysis or Primary Angioplasty Be the Treatment of Choice for Acute Myocardial Infarction?

In the past 20 years, pathological and arteriographic studies have shown that Q-wave myocardial infarction is caused by an occlusive thrombus in a coronary artery. The primary therapeutic objective in a patient with an evolving Q-wave myocardial infarction is the prompt restoration of antegrade flow in the occluded artery. Since both immediate (so-called primary) coronary angioplasty and thrombolysis can restore antegrade flow in most occluded coronary arteries, there is disagreement about which approach is better for evolving infarction.In placebo-controlled, randomized trials involving almost 60,000 patients, thrombolytic therapy has been shown to limit infarct size, improve left ventricular function, and . . .