[Prognostic value of early coronary patency].
According the early-open artery hypothesis, a prompt reperfusion of the ischemic zone in evolving acute myocardial infarction leads to a relevant myocardial salvage with consequent reduction in mortality. This conception has been shaken by the results of GISSI-2 and ISIS-3 trials, in which the same survival was observed in patients treated with either streptokinase or rt-PA, in spite of the well known superiority of rt-PA over streptokinase in reopening the culprit artery. Recently the results of the GUSTO trial have restored the validity of the early-open artery hypothesis. This study shows that a better arterial patency does in fact produce a better survival, provided that thrombolysis is administered very early and reperfusion is fast (with "accelerated" rt-PA) and quite complete (TIMI grade 3), goals not achieved in GISSI-2 and ISIS-3 because in these studies rt-PA was administered in the traditional, not accelerated, way.
Geraci
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Divisione di Cardiologia, Ospedale V Cervello, Palmero.
D015906:Angioplasty, Balloon, Coronary; D002986:Clinical Trials as Topic; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000628:therapy; D011379:Prognosis; D015912:Thrombolytic Therapy; D013997:Time Factors; D014654:Vascular Patency
Valore prognostico della pervietà coronarica precoce.