Role of myocardial contrast echocardiography in the clinical evaluation of acute myocardial infarction.

T he ultimate goal of treatment in acute myocardial infarction (AMI) is to salvage as much myocardium as possible with the least possible risk to the patient. In the immediate aftermath of reperfusion therapy, the clinician must determine whether the infarct related artery (IRA) is patent and if so whether successful myocardial reperfusion has been achieved. Addressing these questions expeditiously is important for subsequent treatment strategies—that is, if thrombolytic therapy has failed then the patient may be transferred for rescue coronary intervention. Furthermore, even when the patency of the IRA is restored, one has to determine whether microvascular perfusion is present. It is also important to identify the presence and extent of residual myocardial viability (MV) following AMI because subsequent revascularisation may not benefit patients with predominant myocardial necrosis, while those patients with significant MV are likely to benefit from revascularisation.