Angioplastie primaire ou thrombolyse lors d'infarctus myocardique aigu: Mise au point

Thrombolytic therapy has been shown to considerably improve the prognosis of acute myocardial infarction (AMI). Its utilization has judiciously increased all over. However, during the last years, there has been growing evidence that primary percutaneous transluminal coronary angioplasty (PTCA) is even better than thrombolysis with respect to reperfusion rate and prognosis, i.e. reinfarction, ventricular function preservation and mortality. PTCA should thus be the first hand treatment in reperfusion therapy during AMI. However, this technique requires specialized and experienced cardiologists, technicians and costly facilities. PTCA is thus restricted to larger hospitals. The time for reperfusion being critical, thrombolysis remains the first line treatment in a patient with usual criteria for reperfusion, when PTCA cannot be performed within 90 minutes. When thrombolysis is contraindicated or cardiogenic shock is associated with AMI, PTCA is the best strategy. In this paper, we review our knowledge in this topic.