This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kennedy, J. W. Articles by Stadius, M. L. Search for Related Content PubMed PubMed Citation Articles by Kennedy, J. W. Articles by Stadius, M. L. Related Collections Cardiovascular Pharmacology Anticoagulant mechanisms Acute myocardial infarction

(Circulation. 1999;99:2714-2716.)
© 1999 American Heart Association, Inc.

Editorial

Combined Thrombolytic and Platelet Glycoprotein IIb/IIIa Inhibitor Therapy for Acute Myocardial Infarction

Will Pharmacological Therapy Ever Equal Primary Angioplasty?

J. Ward Kennedy, MD; Michael L. Stadius, MD

From the Cardiology Division, University of Washington and Veterans Affairs Medical Center, Seattle, Wash.

Correspondence to J. Ward Kennedy, MD, Cardiology Division (111C), VA Medical Center, 1660 S Columbian Way, Seattle, WA 98108.

Key Words: Editorials • angioplasty • thrombolysis • myocardial infarction

The management of acute myocardial infarction (AMI) was altered dramatically with the introduction of intracoronary thrombolytic therapy in the late l970s by Rentrop and others.¹ The visualization of coronary artery occlusion by angiography performed during the first few hours of AMI and the removal of some of these thrombi at the time of emergent coronary artery bypass surgery convinced the medical community that AMI was, as was thought years earlier, due to "coronary thrombosis." After the publication of a number of randomized clinical trials (RCTs) of intracoronary and intravenous lytic therapy, reperfusion of acutely occluded coronary artery beds with thrombolytic therapy became a standard treatment of AMI by the mid-1980s.²

While thrombolytic therapy was gaining early acceptance as a means to achieve reperfusion, a parallel pathway for achieving reperfusion was developing with catheter-based techniques. Reports of PTCA for the management of AMI appeared in 1983.³ Soon a vigorous competition developed between pharmacological and mechanical methods of reperfusion. Important differences between these 2 competing approaches were apparent. Thrombolytic therapy could be initiated rapidly once the diagnosis was made, with treatment instituted in the emergency department or even before hospitalization,⁴ and it did not require the technical skills of a proceduralist for its implementation. However, because reperfusion did not occur until 60 to 90 minutes after the onset of treatment, the occurrence of successful reperfusion (or its failure) could not be ascertained with certainty by use of clinical markers, and there was an obligatory risk of intracranial hemorrhage (ICH) of 0.5% to . . . [Full Text of this Article]

This article has been cited by other articles:

				R. Khouzam, D. Apgar, and B. Phibbs Initial Therapy for Acute Myocardial Infarction: Socioeconomic Implications and Limitations Chest, August 1, 2004; 126(2): 457 - 460. [Abstract] [Full Text] [PDF]

				D. J. Kereiakes, S. C. Smith, A. K. Jacobs, M. J. Kern, and D. P. Faxon Angioplasty for acute myocardial infarction in community hospital without surgical back-up: Response to Wharton and Angelini publications "should guidelines be changed?: Not whether but when" J. Am. Coll. Cardiol., July 1, 2000; 36(1): 299 - 300. [Full Text] [PDF]

				T. P. Wharton Jr., N. Sinclair McNamara, F. A. Fedele, M. I. Jacobs, A. R. Gladstone, and E. J. Funk Reply J. Am. Coll. Cardiol., July 1, 2000; 36(1): 301 - 303. [Full Text] [PDF]

				U. Junghans, R. J. Seitz, H. J. Wittsack, A. Aulich, and M. Siebler Treatment of Acute Basilar Artery Thrombosis with a Combination of Systemic Alteplase and Tirofiban, a Nonpeptide Platelet Glycoprotein IIb/IIIa Inhibitor: Report of Four Cases Radiology, December 1, 2001; 221(3): 795 - 801. [Abstract] [Full Text] [PDF]