ABSTRACT
The most important therapeutic goal in the management of acute myocardial infarction is the early restoration of complete epicardial infarct artery patency and normal myocardial perfusion. The mechanisms of reduction in mortality with fibrinolysis include clot lysis resulting in myocardial salvage, preservation of left ventricular function, and improved left ventricular remodelling. When epicardial flow is restored within 30 minutes of occlusion, myocardial infarction can be aborted. If flow is achieved within two hours, considerable myocardial salvage can occur with beneficial effects on ventricular function and survival. When reperfusion is achieved after two to three hours, myocardial salvage is progressively reduced, and recovery of ventricular function is dependent on established collateral flow. Beyond six hours, myocardial salvage is minimal (1).
