[Detecting reperfusion in patients with acute myocardial infarction]

The patency of the infarct-related coronary artery seems to be an important prognostic factor after an acute myocardial infarction. It is not only related to short term prognosis, specially in the context of cardiogenic shock, but also to long-term prognosis, due to its influence on ventricular remodelling. On the other hand, the assessment of new fibrinolytic treatments require large numbers of patients in multicenter trials for documenting a benefit, when mortality is used as the endpoint. Accordingly, new endpoints will have to be developed, as the patency of the infarct-related coronary artery. Coronary angiography has been used until now to assess coronary patency. However, it is an invasive procedure and its optimal timing after fibrinolytic treatment has not been established. The classic non-invasive methods, like resolution of chest pain, reperfusion arrhythmias, normalization of ST segment elevation and enzymatic determinations, are not very useful, although the combined analysis of these markers increases their accuracy. The imaging methods, specially isotopic but also magnetic resonance imaging, offer interesting possibilities, but they are expensive and not universally available. The usefulness of contrast echocardiography has not been well established. Thus, the diagnosis of myocardial reperfusion by a non-invasive method, sensitive, specific and with a good temporal and spatial resolution, is still an unsolved problem.