INTRAAORTIC BALLOON PUMPING AS ADJUNCTIVE THERAPY TO RESCUE CORONARY ANGIOPLASTY AFTER FAILED THROMBOLYSIS IN ANTERIOR WALL ACUTE MYOCARDIAL-INFARCTION

Although thrombolytic therapy is widely used to restore antegrade coronary blood flow, greater than or equal to 25% of the infarct-related coronary arteries fail to recanalize after thrombolytic therapy.(1) Rescue coronary angioplasty achieves coronary artery patency in a large proportion of patients in whom coronary thrombolysis has failed, but it is associated with a high reocclusion rate and recovery of left ventricular function is minimal.(2,3) The left anterior descending coronary artery supplies the largest amount of the ventricular myocardium, and anterior myocardial infarction is associated with a higher mortality rate than myocardial infarction in different locations. Aggressive forms of management of patients with anterior myocardial infarction have been advocated. Intraaortic balloon pumping is the most reliable method for simultaneously increasing diastolic arterial pressure, while reducing left ventricular load. Intraaortic balloon pumping, if performed after rescue coronary angioplasty, might prevent reocclusion of the coronary artery through augmentation of coronary perfusion and enhance recovery of left ventricular function through left ventricular unloading.(4,5) To test this hypothesis, we performed intraaortic balloon pumping in patients with acute anterior myocardial infarction who underwent rescue coronary angioplasty after unsuccessful thrombolysis.