Angioplastia de resgate no infarto agudo do miocárdio

• Main Author: Moraes, Eraldo Ribeiro Ferreira Leão de [UNIFESP]
• Publication Date: 2007
• Other Authors: Carvalho, Antonio Carlos [UNIFESP]
• Format: Article
• Language: por
• Source: Repositório Institucional da UNIFESP
• Download full: http://dx.doi.org/10.1590/S2179-83972007000400015; http://repositorio.unifesp.br/handle/11600/3472
• topic: Myocardial infarction; Angioplasty; Thrombolytic therapy; Infarto do miocárdio; Angioplastia; Terapia trombolítica

BACKGROUND: Acute myocardial infarction is a serious and frequent illness, and its treatment with thrombolytic therapy or percutaneous coronary intervention (PCI) is well established. Rescue PCI is an alternative when thrombolysis fails. In the last ten years several clinical studies have tested different features about this procedure. METHODS: Eighty four studies about rescue angioplasty published in the major cardiovascular relevance literary sources were analyzed between 1997 to 2007. RESULTS: Rescue PCI was superior to conservative treatment, such as rethrombolysis, when well indicated, and seemed similar to primary PCI, in some features. The concomitant use of GPIIb/IIIa inhibitors seemed to show clinical benefits. The use of drug-eluting stents and the association with mechanic thrombectomy still requires better scientific support. The latest metaanalysis about this topic have shown clear favorable results to rescue angioplasty according to clinical outcomes, heart failure and re-infarction, but not so definite results as to mortality. On the other hand, there was a trend of increased stroke risk, of the same magnitude as benefit. CONCLUSION: Rescue PCI has better results than conservative treatment or repeat fibrinolysis. However, the indication of the procedure still needs more precise selection criteria as well as better definition of the clinical benefit/safety ratio. These uncertainties persist due to the small number of rescue angioplasty procedures compared to the total number of angioplasties performed. In the CENIC Registry, rescue angioplasty amounts to 4% of all angioplasties performed.