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Acute myocardial infarction: enhancing the results of reperfusion therapy.

Reperfusion therapy (by either administration of thrombolytic agents or immediate angioplasty) is the mainstay of treatment of acute myocardial infarction, yet it remains underutilized. Additionally, many patients do not experience optimal reperfusion because of suboptimal flow rate in the infarct-related artery, abnormal microvascular flow, and intermittent or complete reocclusion of the infarct-related artery. Strategies to enhance the results of reperfusion therapy include expanding the population of patients considered as candidates, earlier treatment, newer methods to improve infarct-related artery flow rates, and ancillary treatments currently being studied to reduce reperfusion injury, which may be one cause of decreased microvascular flow. Although aspirin, heparin, and warfarin sodium have been the conventionally used agents for inhibiting thrombin and platelet function, newer agents such as hirudin and inhibitors of the platelet glycoprotein IIb-IIIa receptor are becoming available, and their clinical application will increase in the future.