Acute Myocardial Infarction: Diagnosis and Management

Abstract

Acute myocardial infarction is caused by abrupt thrombotic coronary occlusion. About 1.5 million patients will suffer a heart attack and 10 to 20% of them will die in the U.S.A. annually. Accurate diagnosis and early reopening (reperfusion) of infarct-related coronary artery will lower mortality (2 to 7%) and morbidity of patients and improve their post-MI recovery. There are several effective therapies available to reopen closed infarct-related coronary arteries. Thrombolytic or clot dissolving therapy can be safely used in about one-third of heart attack stricken patients. The expected effectiveness of thrombolytic therapy in treated patients is 70 to 80% of reperfusion rates and 7 to 8% mortality rates. Direct coronary angioplasty of the infarct-related coronary artery represents the most aggressive, yet the most effective reperfusion modality available to all patients suffering from acute MI. Direct angioplasty, when used appropriately, will result in 97 to 99% reperfusion rates and 2 to 3% mortality rates. Aggressive approach to the diagnosis and the treatment of acute MI using either thrombolytic therapy or direct coronary angioplasty holds the greatest promise for clinical success.