Eric R. Bates; ed. 536 pages. New York: Marcel Dekker; 1993. $99.75.

The treatment of myocardial infarction is a rapidly evolving field in contemporary cardiology. No other topic has generated the intense interest and sheer number of research reports on basic mechanisms and clinical trials. The results of this research is often conflicting. Although all the major cardiology textbooks have sections devoted to treatment of acute myocardial infarction, and some specific books have restricted themselves to this topic, none of the available books has what this book has: a range of topics by recognized world leaders and full discussion of the most recent study findings and emerging treatment trends. This book meets the timely need for a concise, balanced discussion of thrombolytic trials, adjunctive pharmacotherapy, and adjunctive mechanical therapy. This extraordinary book is appealing not only because it reviews in detail the trials and current data but also because it develops a practical treatment program and recommendations in a thoughtful and compelling manner. The theory, data, and interpretation are systematically organized, analyzed, and distilled into sensible guidelines.

The use of adjunctive pharmacotherapy in acute myocardial infarction is thoroughly treated in 13 separate chapters. These chapters discuss in detail adjunctive use of classes of agents and their potential benefit. The topics are varied and the discussions are detailed and richly supported with tables and appropriate references. Most chapters close with specific recommendations for appropriate patient selection and treatment guidelines with the agents under discussion. This is a particularly valuable portion of the chapter and it reflects a strong editorial influence in directing a message from each of the chapters. Three additional chapters are devoted to adjunctive mechanical therapy, coronary angioplasty, left ventricular support devices, and coronary bypass surgery. These are important issues that usually receive a cursory discussion in other textbooks. Their appropriate use is critical in achieving satisfactory patient outcomes in high-risk settings. They also alert the internist using thrombolytic therapy to the need for consultation or possible transfer to a tertiary center, or both. These important issues are particularly well discussed.

The final section deals with economic impact and treatment recommendations. The economic data is presented as a model to stimulate discussion of important public policy decisions that will need to be made by third-party payers in the next 10 years. This section provokes more questions than it answers but nonetheless opens the door for what is sure to be a flood of information on the economic impact of practice patterns.

This book represents the most up-to-date, balanced, and effectively edited text available on the treatment of patients with acute myocardial infarction. It is particularly valuable to internists, cardiology trainees, and the practicing cardiologist.