THE SIGNIFICANCE OF CORONARY ARTERIAL PATENCY AND VENTRICULAR-FUNCTION FOR PROGNOSIS AFTER MYOCARDIAL-INFARCTION

This paper assesses the evidence that early, complete and sustained re canalisation of the infarct related artery is the most important facto r in limiting myocardial damage and improving outcome after coronary t hrombosis. Besides the results of experimental studies, clinical suppo rt for the 'open artery' concept comes from, first, the consistent dem onstration that patients with patent arteries survive better that thos e in whom patency is not achieved; second, from the observation that e arly treatment is associated with a better outcome, and third, from th e demonstration that reperfusion by angioplasty or bypass grafting pro duces results as good or better than those of fibrinolytic therapy. Va lidation of adequate reperfusion as both the mechanism of, and a surro gate for, improved clinical outcome encourages 'perfusion endpoint' cl inical trials to develop new reperfusion strategies. (C) 1998 Elsevier Science Ireland Ltd.