[Primary angioplasty: this balloon is of general interest, indeed].

Rev Esp Cardiol 2002;55(6):565-7 565 «The benefit obtained from early reperfusion of the occluded artery limits the size of infarction, reduces the degree of ventricular dysfunction and improves survival.»1 This classic statement made by a classic cardiologist (Eugene Braunwald) is the first enunciation of the hypothesis that favorable consequences derive from the early restoration of blood flow in the occluded artery responsible for acute myocardial infarction (AMI). This hypothesis reached the status of a theory with the publication of the results of GUSTO I. This prospective, randomized, multicenter, and multinational study compared four different thrombolysis guidelines in 40 000 patients with AMI. The angiographic substudy of 1200 patients in whom angiographic evaluations were made at different intervals converted the Braunwald hypothesis into theory and demonstrated, for the first time, a direct relation between TIMI 3 flow in the artery responsible for infarction 90 min after thrombolytic treatment and 30day survival.2 All the therapeutic strategies designed to achieve the best possible result in patients with AMI have had the ultimate goal of obtaining the maximum coronary bloodflow in the artery responsible for infarction in the largest possible percentage of patients. The primary angioplasty plan published in this number of the REVISTA ESPAÑOLA DE CARDIOLOGÍA, inaugurated in the region of Murcia by the Cardiology Department of Hospital de la Arrixaca, headed by Dr. Mariano Valdés, is a commendable effort designed to improve the possibilities of reperfusion in the largest possible number of patients with AMI in this autonomic community.3 The search for an ideal reperfusion strategy has always been guided by the following cardinal points: effectiveness, time, applicability, and cost. 1. Beginning with cost, we observed that although it is a very important concern when comparing two therapeutic strategies, it has not originated a great deal of controversy due to the difficulty of comparing the relative costs of each treatment, especially when clinical results, including mortality, are different. The scant data available indicate that, although the cost of the acute episode and the first hospitalization are slightly greater in patients treated by primary angioplasty, the costs tend to equalize, with a slight balance in favor of angioplasty, due to the greater cumulative incidence of new hospitalizations and revascularization treatment after the acute episode in patients treated with thrombolysis.4 2. The difficulties of applying primary angioplasty in a generalized way as the treatment of choice for patients with AMI has been cited as the main argument in favor of thrombolysis in debates comparing both treatments. Thrombolytic treatment does not require infrastructure or special training, whereas primary angioplasty does in order to guarantee the desired results. Diverse strategies for increasing the applicability of primary angioplasty have been tried, with different results depending on the infrastructure, preparation, and motivation of centers. The program started by the team of Dr. Valdés has important merits: a) it has been born with the aim of offering reperfusion by primary angioplasty to a larger number of patients than thrombolytic treatment currently offers, and with the vocation of extending the use of the procedure to all the patients in the autonomic community; b) it has made a point of preparing a team of cardiologists, nurses, and technicians to guarantee a permanent service and adequate clinical results, and c) it is coordinated with emergency transport services and other hospital centers in an attempt to minimize the delay in treatment that mechanical reperfusion by primary angioplasty necessarily entails.5 3. Another one of the theoretically weak points of primary angioplasty is the inherent delay in preparation for applying this type of treatment. The coined phrase «time is muscle» refers to the importance of minimizing the delay from the onset of symptoms to the application of treatment. While true for any reperfusion strategy in patients with AMI, delay is so critical in patients treated with thrombolysis it has been ED I TO R I A L S