ABSTRACT
In acute MI with ST elevation, the infarct vessel is completely occluded by a thrombus in more than 90% of patients. Therefore, immediate restoration and maintenance of bloodflow at the site of the culprit lesion is of crucial importance (TIMI III flow; ‘time is muscle’). This can be achieved by two procedures: thrombolysis and acute percutaneous interventions. Time since onset of symptoms and recanalization of the infarct vessel correlate strongly and in a non-linear fashion with infarct size and risk of death. Restoration of bloodflow within the first hour after vessel closure is associated with excellent outcome, but every further delay means considerable loss of myocardium with increase in infarct size, less effectiveness in preservation of potentially viable myocardial tissue, and worse prognosis.
