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The success of thrombolytic therapy for acute myocardial infarction is limited by failure of reperfusing 25% of occluded arteries, bleeding complications in 0.4 to 1% of patients and the possibility of recurrent ischemia. These problems can be overcome by the use of immediate angioplasty without previous thrombolytic therapy. Between February and December 1993, twelve patients (ten men and two women) admitted for acute myocardial infarction were treated by immediate angioplasty. Five patients had a contraindication to thrombolysis and seven had angioplasty as a deliberate choice. Successful recanalisation was obtained in 11 patients (92%) with one reocclusion at 24 hours. Two patients admitted in cardiogenic shock 12 hours after the onset of symptoms died lately with multiorgan failure. Only one case of clinical restenosis was observed and was redilated. In conclusion, immediate angioplasty without prior thrombolytic therapy is a rapid method of revascularisation with minimal risk and good outcome when it is used early after acute myocardial infarction.
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