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A little over 50 years ago, my father had a heart attack. He was driven to the hospital by friends after having “indigestion” for 2 days. He spent 2 weeks as an inpatient on an unmonitored rehabilitation ward and was treated principally with warfarin and digitalis. He was lucky and survived, but in that era, more than 20% of patients with an acute myocardial infarction died. Fastforward to today, when public education about early recognition of symptoms, emergency transport, monitored coronary care units, and early reperfusion by means of primary percutaneous coronary intervention (PCI) have markedly reduced mortality from acute myocardial infarction to less than 5% | Improving Reperfusion in Patients with Myocardial Infarction Improving Reperfusion in Patients with Myocardial Infarction George W. Vetrovec M.D. A little over 50 years ago my father had a heart attack. He was driven to the hospital by friends after having indigestion for 2 days. He spent 2 weeks as an inpatient on an unmonitored rehabilitation ward and was treated principally with warfarin and digitalis. He was lucky and survived but in that era more than 20 of patients with an acute myocardial infarction died. Fastforward to today when public education about early recognition of symptoms emergency transport monitored coronary care units and early reperfusion by means of primary percutaneous coronary intervention PCI have markedly reduced mortality from acute myocardial infarction to less than 5 . Major contributors to this remarkable improvement in outcome are based on pathological studies1 2 showing thrombotic occlusion of an artery associated with acute myocardial infarction Fig. 1A in parallel with diagnostic and therapeutic advances from cardiac catheterization laboratories. By performing coronary angiography during evolving myocardial infarction DeWood et al.3 observed total coronary-artery occlusion in patients with acute myocardial infarction with frequent early spontaneous reperfusion. Coincidentally angiographic features of the thrombus were characterized helping to identify the role of clots in acute coronary syn-dromes.4 5 Most of the remarkable improvements have occurred over the 30 years since the introduction of coronary angioplasty.6 Rentrop et al.7 demonstrated that reperfusion with the use of mechanical or thrombolytic revascularization could avert evolving infarction. Most recently the recognized importance of early and complete reperfusion by means of PCI has led to a strategy of using PCI as the preferred therapy for acute myocardial infarction with a goal of reestablishing flow within 90 minutes after presentation i.e. a door-to-balloon time
