Percutaneous transluminal coronary angioplasty in the treatment of patients with unstable angina and acute myocardial infarction

Percutaneous transluminal coronary angioplasty has enjoyed a high success rate in the treatment of unstable angina pectoris. A 'culprit lesion' frequently can be identified and dilated. Recent evidence indicates that thrombosis is often involved at this site and studies are currently underway to determine the value of adjunctive antithrombotic measures. Angioplasty also has been shown to be possible in the acute phase of myocardial infarction. Intravenous thrombolytic therapy is currently the treatment of choice, however, and acute angioplasty should be reserved for those patients who have contraindications to treatment with fibrinolytic drugs or in whom such treatment fails. In the stable patient who has received thrombolytic therapy, angioplasty should be deferred until at least 1 or 2 days after thrombolysis. Car of the patient who has undergone acute angioplasty should be guided by the recognition that reocclusion rates following this therapy are significantly higher than in elective situations.