tailieunhanh - EDUCATION IN HEART VOL 3 - PART 2

Trong những năm qua thay đổi sâu sắc trong cả hai điều trị modalities1-3 w1 w2 đã thay đổi đáng kể các đối số này từ lâu bằng chứng cho thấy rằng việc sử dụng thay thế của chính nong mạch vành | 4 ACUTE MYOCARDIAL INFARCTION REPERFUSION TREATMENT Flavio Ribichini William Wijns The decision over whether to treat acute myocardial infarction AMI with a balloon or infusion of fibrinolytics remains controversial. During the past few years profound changes in both treatment modalities1-3 w1 2 have substantially changed the arguments surrounding this longstanding The evidence shows that the alternative use of primary angioplasty or fibrinolysis is rarely an option either because angioplasty is simply not available or because the patient is not eligible for fibrinolysis. This evidence reflects the difference in applicability of each treatment that is the proportion of patients in whom only one of the treatments would be suitable versus patients in whom either treatment would be appropriate. As a matter of fact primary angioplasty is applicable to almost all victims of AMI 82-90 of patients randomised to primary angioplasty actually undergo the procedure but it is not available to the majority of patients. Conversely fibrinolysis is a widely available treatment but applicable to a variable percentage of patients which does not reach 50 . The large number of patients with AMI to whom fibrinolysis is not administered represents a big challenge for the future and perhaps the most rational and undisputed argument in favour of the use of primary angioplasty. The best reperfusion treatment is one that achieves the highest rate of early complete and sustained infarct related artery patency in the largest number of patients but with the lowest rate of undesirable effects. The results obtained with both treatments in the way they were applied before the latest breakthroughs in the field can be represented by a geometrically opposing relation between applicability and efficacy fig . c UNCONTROVERSIAL EVIDENCE IN FAVOUR OF FIBRINOLYTIC TREATMENT Clinical trials and experience have identified the following landmarks in the reperfusion treatment of ST segment .