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(Circulation. 1997;96:2762-2764.)
© 1997 American Heart Association, Inc.

Articles

Keeping the Open Artery Open

Is Stenting the Answer?

Joseph P. Carrozza, Jr, MD; ; Donald S. Baim, MD

From the Section of Interventional Cardiology, Beth Israel-Deaconess Medical Center, Boston, Mass.

Correspondence to Joseph P. Carrozza, Jr, MD, Section of Interventional Cardiology, Beth Israel-Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215.

Key Words: Editorials • stents • restenosis

	Introduction

 
In the past decade, studies of thrombolytic therapy have established definitively that early patency of the infarct-related vessel is associated with improved left ventricular performance as well as enhanced in-hospital and long-term survival.^{1 2} Importantly, these reductions in early (30-day) and long-term (5-year) mortality are highly correlated with the restoration of normal (TIMI grade 3) versus TIMI grade 2 flow or less at discharge.^{3 4} Although thrombolytic regimens achieve arterial "patency" in almost 90% of patients, they restore TIMI grade 3 flow by 90 minutes in only 50% of patients.

Another limitation of thrombolytic therapy is that 10% of patients in whom successful reperfusion is obtained initially experience reocclusion before hospital discharge, and in 30%, the infarct-related artery reoccludes within 1 year.⁵ Although reocclusion is often clinically silent, it tends to negate the benefits of early reperfusion and is associated with poorer left ventricular function and higher long-term mortality. Taken together, these studies support what has been called the "open-artery" paradigm and further suggest that rapid reestablishment and maintenance of TIMI grade 3 blood flow are essential to achieving the best long-term outcome.

Our understanding of what role balloon angioplasty should play in treating the culprit vessel in acute myocardial infarction has evolved substantially over the past decade. Because acute coronary thrombosis usually occurs at the site of a ruptured atherosclerotic plaque, it seems intuitively obvious that balloon dilatation immediately after thrombolysis should reduce the underlying residual stenosis and thus improve coronary blood flow and clinical outcome. Unfortunately, the TIMI-2 trial showed . . . [Full Text of this Article]

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