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Coronary Angioplasty for Acute Myocardial Infarction

Eric J. Topol, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: Eric J. Topol, MD, Director, Cardiac Catheterization Laboratory, B1-F245, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0022.

Current Author Address: Dr. Topol: Director, Cardiac Catheterization Laboratory, B1-F245, University of Michigan Medical Center, 1500 E. Medical Center Drive, Ann Arbor MI 48109-0022.

© 1988 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1988;109(12):970-980. doi:10.7326/0003-4819-109-12-970
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Purpose: To critically review the role of coronary angioplasty for acute myocardial infarction.

Data Identification: Studies published from January 1982 to June 1988 were identified through a search of the English-language literature using MEDLINE and thorough extensive hand searching of bibliographies of identified articles.

Study Selection: All consecutive patient series and randomized trials of coronary angioplasty for acute myocardial infarction.

Data Extraction: Demographic characteristics, technical results, clinical outcomes, and left ventricular function results were collated.

Results of Data Synthesis: Three randomized trials have compared immediate and deferred coronary angioplasty after intravenous tissue plasminogen activator. Immediate angioplasty was associated with increased mortality, increased need for emergency bypass surgery, higher transfusion requirement, and no benefit in terms of left ventricular functional recovery.

Conclusions: The role of coronary angioplasty for myocardial infarction has thus far been established as adjunctive, in a delayed time frame after thrombolytic therapy. Coronary angioplasty has not been shown to reduce in-hospital mortality or improve resting left ventricular function. A deferred strategy has improved exercise left ventricular performance, and several follow-up studies suggest a favorable long-term prognosis.





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