[Facilitated angioplasty: neither black nor white].

Rev Esp Cardiol. 2005;58(2):111-8 111 The first thing to remember when judging ST-segment elevation acute coronary syndrome (STEACS) treatments is that the underlying mechanism is usually the rupture or erosion of an atherosclerotic plaque and consequent thrombus formation causing complete coronary artery occlusion. Although clinical consequences remain devastating, therapeutic advances in recent decades have significantly reduced mortality in acute myocardial infarction and improved long-term prognosis and quality of life.1 In this situation, the initial fundamental priority must be to combat arrhythmias and achieve rapid, efficient restoration of epicardial and microvascular flow. Efficient, early myocardial reperfusion at the onset of necrosis limits infarction size, reduces ventricular dysfunction and improves survival.2 Two established strategies achieve this: drug therapy using thrombolytic agents, and mechanical intervention by primary angioplasty. Both have advantages and disadvantages. In optimal conditions, primary angioplasty appears more efficient than thrombolysis in restoring coronary flow and improving the clinical evolution of patients with STEACS.3 However, because of inherent logistic and technical limitations angioplasty can be performed in only a small proportion of patients with infarction.4-6 In contrast, intravenous thrombolysis reduces short-term mortality and is indicated in most patients with STEACS.7 Moreover, bearing in mind the current availability of new, more easily administered thrombolyED I TO R I A L S