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Reperfusion therapy for acute myocardial infarction: historical context and future promise

E. Braunwald*

Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts, USA

* Correspondence: Eugene Braunwald, MD, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA

Abstract

Reperfusion therapy for acute myocardial infarction is a milestone achievement in 20th century cardiology. This article tracks this therapy from the discovery that coronary thrombosis is the cause of myocardial infarction, through the pre-clinical era when studies in dogs demonstrated the benefit of early reperfusion. Then came early clinical observations in the feasibility of coronary thrombolysis in patients, followed by the early placebo-controlled megatrials (GISSI-I and ISIS-2), which showed a substantial mortality benefit. During the past decade there have been important refinements using ambulance-based therapy, new bolus thrombolytics, adjunctive glycoprotein inhibitors and percutaneous coronary intervention.

Key Words: Acute myocardial infarction • cardiovascular disease • reperfusion • ST-elevation myocardial infarction • thrombolytic therapy

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This Article
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