Thrombolytic therapy in AMI restores
infarct artery patency, preserves LV function, and decreases hospital mortality. Although hemorrhagic complications including
stroke can occur, the incidence of
stroke is not increased compared with control groups.
Aspirin must be administered as soon as possible to inhibit platelet function, and an adjunctive role for early beta-blocker
therapy may be important. Acute cardiac catheterization and coronary angioplasty need not be routinely performed in stable patients after tPA
therapy, but should be considered in unstable patients. Two trials suggest that aggressive use of coronary angioplasty or bypass graft surgery before hospital discharge to preserve
infarct artery patency and to prevent postinfarction
ischemia is associated with an important improvement in long-term prognosis.
Thrombolytic therapy should be considered standard care for patients whose ischemic
chest pain lasts 20 min to at least 6 h in duration and who have an injury current on their ECG unless they are at increased risk for
bleeding. The need for and timing of cardiac catheterization, coronary angioplasty, and surgical revascularization after AMI requires further evaluation.