Summary
The selection of the reperfusion therapy (thrombolysis, PTCA, or no reperfusion) in
acute myocardial infarction should depend on the riskbenefit ratio, the availability,
and the costs. Thrombolysis is available everywhere and is the standard of reperfusion
therapy, but carries the risk of intracranial haemorrhage. PTCA is more effective
with less risk, but it is also more expensive and available only in specialised centres.
In current clinical practise in Germany, the only important determinant for using
PTCA as a reperfusion strategy is the availability of a catheter laboratory. Besides
availabilty, the selection of reperfusion therapy should be made more on clinical
relevance: (i) PTCA especially in patients with a large benefit, the presence of contraindications
to thrombolysis, or in cardiogenic shock, and (ii) thrombolysis, if PTCA is not immediately
available.
Key words
Thrombolysis - PTCA - risk-benefit - clinical practice
