This review summarizes the current knowledge based on the optimal initial revascularization strategies for acute myocardial infarction. Although the available randomized clinical trial data strongly supports the benefits of primary angioplasty over thrombolysis, the interpretation of these and other randomized trials fail to account for the wide interindividual differences in broad cohorts of patients. It is essential to explore which specific subsets of patients will benefit from each of these successful strategies. Clearly one size (of treatment) does not fit all.
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