| Abstract | Acute myocardial infarct management has changed dramatically in the last decade as the results of major randomized clinical trials have been reported(1-17). The choice of thrombolytic drug, anti-thrombotic regimen, and role of direct coronary angioplasty are evolving and the subject of an intense research effort. The average reduction in mortality rates for patients treated within 6 and 12 hours of symptom onset is 30% and 20%, respectively. However, approximately 20% of infarct related vessels do not open with thrombolytic regimens and 10-15% of reperfused arteries reclose within 3 or 4 days of reperfusion, adversely affecting left ventricular remodeling and long-term prognosis. The controversies in thrombolytic and anti-thrombotic regimens are partially reviewed elsewhere(9-11, 18). The open vessel hypothesis has had a major impact on therapeutic regimens and risk stratification of acute infarct patients(19). Patients who have the best prognosis have an open vessel at 90 minutes with sustained patency to the time of hospital discharge (Figure 1). An open infarct vessel is associated with limited infarct size, improved myocardial healing, limited infaret expansion, reduced aneurysm formation, and results in secondary benefits of diminished arrhythmias, reduced thrombo-embolic rates, decreased episodes of heart failure and a lower mortality rate. |
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