Beyond Epicardial Reperfusion

The pathogenesis of an acute myocardial infarction consists of the rupture of atherosclerotic plaque, followed by a sudden thrombotic coronary occlusion. Pioneering studies performed more than 40 years ago, even before there was full recognition of the underlying pathobiology, showed that nonselective intracoronary fibrinolysis can restore perfusion to the jeopardized vascular territory.1 Primary percutaneous coronary intervention (PCI) has now emerged as the optimal mode of reperfusion therapy, if performed by an experienced team within 90 minutes after the first medical contact. Primary PCI results in patency of the occluded artery in almost all patients and in normalization of epicardial perfusion, . . .