ABSTRACT
INTRODUCTION The pivotal animal experiments of Reimer et al., which demonstrated the wavefront phenomenon of myocardial necrosis (1), led to the correct assumption that restoration of flow in an infarct artery would salvage myocardium and improve clinical outcomes. Indeed, reperfusion therapy has transformed the management of ST-segment elevation myocardial infarction over the last 30 years. Considerable endeavor has been undertaken in comparing the two principal reperfusion modalities: fibrinolysis and primary percutaneous coronary intervention (PPCI). Many randomized trials as well as a pooled meta-analyses have led to the consensus that, all things being equal, PPCI is the preferred therapy when performed by experienced operators in accredited institutions (2), leading to fewer deaths, reinfarctions, and strokes than fibrinolysis. The benefits of PPCI over fibrinolysis may relate to the achievement of infarct vessel TIMI 3 flow in the vast majority, stabilization of the ruptured, unstable plaque resulting in less reocclusions and the avoidance of hemorrhagic complications (particularly intracranial hemorrhage) associated with fibrinolysis.
