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Angioplasty versus thrombolysis for acute myocardial infarction.

Both direct angioplasty and thrombolytic therapy can decrease mortality from acute myocardial infarction, but certain subgroups of patients benefit more from one method than the other. Direct angioplasty is favored in patients in cardiogenic shock (with perhaps the exception of those who are elderly or have three-vessel coronary disease) and patients who have undergone previous coronary bypass surgery. Thrombolytic therapy and direct angioplasty seem to be equally effective in patients with acute myocardial infarction who present more than 6 hours after onset of symptoms or have multivessel coronary artery disease. The location of the infarct (anterior versus inferior) does not favor one therapy over the other. We believe that in most patients, the best approach is to begin with thrombolytic therapy and to follow that with selective application of angioplasty when it is clinically appropriate.