The Aggressive War on Acute Myocardial Infarction: Is the Blitzkrieg Strategy Changing?

Evolution in the treatment of patients with acute myocardial infarction has taken us, within a brief period of less than 40 years, from impotent observation to aggressive invasive intervention designed to open suddenly occluded coronary arteries. The attack on the patient with acute myocardial infarction, requiring sophisticated catheterization facilities and personnel immediately available at all times, takes on many of the attributes of battlefield evacuation, complete with helicopters and pseudo-MASH units. The concept that led to this approach was the resuscitation of the idea that thrombus over a plaque was the most important mechanism of sudden obstruction in transmural myocardial infarction. Chazov et al1in the Soviet Union were the first to demonstrate fibrinolysis by intracoronary streptokinase. Rentrop et al2stimulated general interest in intracoronary thrombolysis. Later, Schroder et al3demonstrated that the occluded coronary artery could be opened by intravenous streptokinase. The first randomized, controlled study