Temporary Vs Definitive Reperfusion

The seminal contribution by DeWood et al. (24) highlighted the importance of arterial thrombus in the initiation and propagation of the events leading to myocardial necrosis. In the majority of cases, thrombus dissolution induced by lytic agents leaves behind a significant coronary stenosis, which serves as a substrate for recurrent ischemic

Fig. 4. Mortality (30-d) and 90-min infarct-artery TIMI flow. Adapted from ref. 17.
Fig. 5. Impact of pre-angioplasty TIMI flow grade on 6-mo mortality in patients undergoing mechanical reperfusion. Reproduced with permission from ref. 23.

events. Thus, a large proportion of patients have revascularization procedures before hospital discharge, or within the first few months after an acute MI. This varies with physician preference, availability, and prevailing clinical practice. For example, among the 21,772 patients enrolled in the United States in the GUSTO I trial, 71 and 58% underwent coronary angiography and revascularization, respectively, prior to hospital discharge (25). Successful primary angioplasty virtually eliminates residual high-grade stenoses in the infarct artery, at least until restenosis occurs.

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