Tailored reperfusion therapy of patients with evolving myocardial infarction: Models to guide clinical decision making

Myocardial infarction is one of the leading causes of death among adults in the Western World. In The Netherlands, yearly approximately 20,000 men and 10,000 women are admitted with this disease, which is responsible for circa 12% of annual mortality (figure). Myocardial infarction is an acute coronary syndrome, which may happen during the chronic process of coronary atherosclerosisp· At a certain stage in this process fissuring and disruption of the growing atherosclerotic plaque may occur, initiating intraluminal thrombus formation. Such thrombi may cause total occlusion of the coronary artery, so that oxygen delivery to the myocardium is blocked. IE th is situation persists for more than 30 minutes, irreversible damage to the myocardium, i.e. myocardial infarction, will occur. Prolonged duration of coronary occlusion results in a progressive increase of the infarcted area, until the whole area at risk becomes necrotic. Generally, after approximately six hours of continuous occlusion the infarct has reached its full extension. Although the notion that myocardial infarction is caused by acute coronary thrombosis was already advanced in the beginning of this century, the correctness of this idea was demonstrated only in the early 1980s, by studies of DeWood et al. Since that time, treatment strategies have been introduced that aimed at rapid and lasting restoration of the coronary blood circulation. The overall benefits of these 'reperfusion' strategies have been established unequivocally.

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