The open-artery hypothesis.
Early reperfusion of an infarct-related coronary artery results in myocardial salvage, with subsequent improvement in left ventricular function and survival. However, late reperfusion, which occurs at a time when myocardial salvage is no longer possible, still exerts a favorable impact on left ventricular function and survival. This concept is known as the open-artery hypothesis. Possible mechanisms for this benefit include improved infarct healing, limitation of ventricular remodeling, decreased ventricular arrhythmias, and reperfusion of hibernating myocardium. Although an open infarct-related coronary artery is crucial, it has not been proven that opening an occluded coronary artery using angioplasty is beneficial. A large randomized clinical trial is clearly needed.
Solomon
A
A
Georgetown University Medical Center, Division of Cardiology, Washington, DC 20007, USA.
Gersh
B
B
D015906:Angioplasty, Balloon, Coronary; D001145:Arrhythmias, Cardiac / Q000517:prevention & control; D003331:Coronary Vessels / Q000473:pathology* / Q000503:physiopathology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D009203:Myocardial Infarction / Q000473:pathology / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D017682:Myocardial Stunning / Q000628:therapy; D013997:Time Factors; D014022:Tissue Survival / Q000502:physiology; D014654:Vascular Patency; D018754:Ventricular Dysfunction / Q000517:prevention & control; D016277:Ventricular Function, Left / Q000502:physiology; D014945:Wound Healing