Acute coronary syndromes: the clot is there

Attempts to extract clot from an infarct-related coronary artery have underestimated the frequency and pathophysiologic significance of thrombus in acute coronary syndromes. The overwhelming body of evidence garnered over the last 20 years, especially the achievement of reperfusion (Thrombolysis In Myocardial Infarction trial grade 2 and 3 flow) with most of the newer thrombolytic agents in >80% of cases, incontrovertibly establishes a critical role for thrombus in acute occlusive coronary artery disease.