A randomized trial of late reperfusion therapy for acute myocardial infarction. Thrombolysis and Angioplasty in Myocardial Infarction-6 Study Group.

Abstract

The study demonstrates that it is possible to achieve infarct vessel recanalization in the majority of late-entry patients with either thrombolytic therapy or angioplasty. Thrombolytic intervention had a favorable effect on prevention of cavity dilatation and left ventricular remodeling, but there are no late benefits on systolic function after thrombolysis or coronary angioplasty. The conclusions concerning overall potential benefit of applying late reperfusion therapy will require data from large-scale trials designed to assess mortality reduction.

Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function

“…4,6,7 In spite of the efficacy of stenting of coronary occlusions, 15,16 studies using routine stenting and showing excellent longterm patency have continued to show mixed or inconclusive results. 3,5 The postulated mechanisms underpinning the potential benefits of late opening of the IRA center on improvement of LV function and reduction of LV remodeling.…”

“…Randomized studies examining this hypothesis have been inconclusive. [3][4][5][6][7] Post hoc analyses suggesting marked improvement in LV function if infarct-related artery (IRA) patency is maintained 6 do not prove an effect of late reperfusion; both patency and function may be preserved because of less microvascular dysfunction or more viable myocardium. Thus, whether to revascularize occluded coronary arteries in the subacute phase of myocardial infarction (MI) continues to be debated.…”

Development and Evaluation of a New Canine Myocardial Infarction Model Using a Closed-Chest Injection of Thrombogenic Material

“…[21][22][23] In the present model, thrombi formed in the left anterior descending coronary artery distal to the first diagonal branch. LVEF decreased 0.5 h after coronary artery occlusion and did not recover even 4 weeks after occlusion even though the coronary arteries spontaneously reperfused within 3 days after occlusion.…”

Reduction of Ischemic, Pharmacological and Remote Preconditioning Effects by an Antioxidant N-Acetyl Cysteine Pretreatment in Isolated Rat Heart

“…2) Timely restoration of coronary blood ‰ow by pharmacological agents and coronary angioplasty 3) has been successfully used to limit myocardial infarct size. Furthermore, reperfusion of ischemic myocardium has its own inherent limitation to produce reperfusion injury.…”