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(Circulation. 1995;91:1905-1907.)
© 1995 American Heart Association, Inc.
Articles |
Optimal Management of Acute Myocardial Infarction Requires Early and Complete Reperfusion
From the Division of Cardiology, University of Washington, Seattle, Wash.
Correspondence to J. Ward Kennedy, MD, University of Washington, Division of Cardiology, RG-22, 1959 NE Pacific Street, Seattle, WA 98195.
Key Words: Editorials • myocardial infarction • reperfusion
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Introduction |
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Thrombolytic therapy for the treatment of acute myocardial infarction (AMI) began more than 15 years ago with the initial observations of Rentrop et al1 and others2 that demonstrated the feasibility of reperfusing totally occluded coronary arteries in patients with AMI with the infusion of intracoronary streptokinase (ICSK). The intracoronary route of administration was hampered by the need for early cardiac catheterization, delaying the initiation of therapy, which many believed made this approach to treatment impractical. Despite this limitation, intracoronary thrombolytic therapy resulted in patency rates that were generally higher and achieved more rapidly than intravenous therapy once treatment was begun. One of the earliest trials of intracoronary therapy, which randomized patients early in the course of AMI, demonstrated improved left ventricular function as compared with control patients, a finding that many randomized trials of intravenous thrombolytic therapy have failed to demonstrate.3 One of the great advantages of intracoronary administration over the intravenous route is the immediate angiographic demonstration of the success or failure of the therapy. In our Western Washington ICSK trial,4 5 we randomized 250 patients to either ICSK or no thrombolytic therapy. All patients underwent immediate coronary angiography and were randomized after the identification of a partially or totally occluded infarct-related coronary artery. Of the vessels that were totally occluded at the time of the initiation of the streptokinase infusion, 67% completely reperfused at an average of 31 minutes after the onset of therapy. The adequacy of coronary artery reperfusion was judged by an angiographic reading committee that classified
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