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The reperfusion era. Strategies for establishing or maintaining coronary patency
1Division of Cardiology, Penn State University College of Medicine, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA. jmf5@psu.edu
Insights
The thrombus (blood clot) is the primary cause of myocardial infarction (MI) and unstable angina. This review covers acute coronary syndromes (ACS), patient triage, and evidence-based therapies for acute coronary lesions.
Area of Science:
- Cardiology
- Vascular Biology
- Clinical Medicine
Background:
- Historically, the origin of coronary artery thrombus in myocardial infarction (MI) was debated.
- Acute clinical angiographic studies established thrombus as the proximate cause of MI and unstable angina.
- Significant advancements in the 20th century led to the collective classification of acute coronary syndromes (ACS).
Purpose of the Study:
- To review key pathophysiological concepts of acute coronary syndromes (ACS).
- To present an initial strategy for patient triage in ACS.
- To summarize evidence-based medicine guiding therapy for acute coronary lesions.
Main Methods:
- Review of pathological and experimental evidence.
- Analysis of acute clinical angiographic studies.
- Synthesis of data from over 75,000 patients randomized in ACS clinical trials.
Main Results:
- Established the thrombus as the direct cause of MI and unstable angina.
- Delineated the spectrum of disorders now known as ACS.
- Provided a foundation for evidence-based management of ACS.
Conclusions:
- Thrombus formation is central to the pathophysiology of MI and unstable angina.
- A structured approach to patient triage is essential for effective ACS management.
- Evidence-based therapies significantly impact outcomes in patients with acute coronary lesions.
Abstract:
Only 3 decades ago, controversy existed over the origin of the thrombus that occluded coronary arteries during myocardial infarction (MI). Then, the acute clinical angiographic studies of DeWood butterssed new pathological and experimental evidence that the thrombus was the proximate cause of MI and unstable angina. The remaining years of the 20th century saw an explosion of knowledge delineating a spectrum of related disorders now collectively called acute coronary syndromes (ACS). The clinician managing patients is confronted with an array of evidence as more than 75,000 patients worldwide have been randomized to clinical trials in ACS. This article reviews key pathophysiological concepts, presents an initial strategy for triage of patients, and summarizes evidence-based medicine guiding therapy for acute coronary lesions.