Coronary Artery Patency and Survival in Clinical Trials.

Central to many of the major advances seen in the treatment of acute myocardial infarction over the last 15 years has been the concept that reperfusion by thrombolytic therapy, by producing early patency of an infarct-related artery, salvages myocardium and preserves left ventricular function. Large clinical trials have confirmed the mortality benefits of thrombolytic therapy, which has become the standard worldwide treatment. It is increasingly evident that complete reperfusion (TIMI 3 flow) is needed to achieve the optimum patient outcome. In addition, the benefits of microvascular reperfusion are now being recognized. The evaluation of new regimens and therapies to improve early patency are exciting current developments. Recently it has been shown for the first time that late patency of the infarct-related artery is an independent predictor of survival. This extension of the open-artery theory has major implications for both the treatment of acute myocardial infarction and future thrombolytic and revascularization policies for surviving patients.