Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction

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.6In the early 1980s, a study of percutaneous coronary angioplasty of an occluded coronary artery in STEMI without the use of a thrombolytic was published for the first time.7 This approach has been compared to intravenous fibrinolysis (first streptokinase and later fibrin-specific lytics) and showed a reduction of …