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(Circulation. 2009;119:3047-3049.)
© 2009 American Heart Association, Inc.

Editorial

Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction

Trials, Registries, and Guidelines

Freek W.A. Verheugt, MD

From the Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.

Correspondence to Freek W.A. Verheugt, MD, FESC, FACC, Department of Cardiology, Onze Lieve Vrouwe Gasthuis, PO Box 95500, 1090 HM Amsterdam, the Netherlands. E-mail f.w.a.verheugt@olvg.nl

Key Words: Editorials • angioplasty • fibrinolysis • myocardial infarction • reperfusion

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Reperfusion therapy represents an important step forward in the management of patients with ST-segment elevation myocardial infarction (STEMI). Few medicinal treatments have been evaluated so well. In numerous randomized controlled trials, reperfusion therapy proved to reduce infarct size and improve early and long-term clinical outcome when compared with control treatment. The cornerstones of reperfusion therapy include both early complete recanalisation of the infarct-related artery and maintained patency over the long term.

Article see p 3101

Nearly half a century ago, the first experience with reperfusion therapy for STEMI using fibrinolytic agents was reported, but most studies were small and had no strict electrocardiography criteria.¹ In the late 1970s, the first randomized trial of intravenous streptokinase infusion in patients with acute (<12 hour) STEMI showed a large early mortality reduction of 50%, but this trial was too small to be conclusive.² In the same time period, Rentrop performed the first percutaneous coronary recanalisation procedure in STEMI using a guide wire to dislodge occlusive coronary thrombus, which resulted in coronary reperfusion.³ The concept of an occluded coronary artery by atherothrombosis was convincingly proven by Dewood in 1980, where in most cases of STEMI an abrupt coronary closure was observed.⁴ In the 1980s, many randomized trials comparing intracoronary and later intravenous thrombolytic therapy with placebo/control showed an unequivocal benefit in early mortality with an acceptable bleeding risk.⁵ The reduction in mortality was based on the reduction of infarct size and proved to be maintained over a long-term follow-up.⁶

In the early 1980s, a . . . [Full Text of this Article]

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