Therapy of acute ST-elevation myocardial infarction (STEMI) has undergone dramatic improvements during the past three decades, and in-hospital and 30-day mortality rates have tremendously decreased from .15–20% in the pre-thrombolytic area to 8–10% using fibrin-non-specific agents, to 6–8% using fibrin-specific thrombolytic agents, and down to 4.5% by the use of primary percutaneous coronary in...

Aggressive reperfusion therapy for myocardial infarction (MI) characterized by acute ST-segment elevation leads to improved patient outcome. Furthermore, use of thrombolytic therapy is highly time-dependent: reperfusion therapy is beneficial within 12 h, but the earlier it is administered, the more beneficial it is. Thus, the focus of both prehospital and emergency department management of pati...

Reperfusion therapy has lowered the mortality in patients suffering acute myocardial infarction. Failure to reperfuse is associated with significantly higher risk of short- and long-term mortality. Detection of reperfusion is thus important. In a prospective pilot study, we used continuous on-line computerized vectorcardiography to monitor 21 patients with acute myocardial infarction treated wi...

While coronary thrombolytic therapy in clinical practice is well established for acute myocardial infarction, the injury associated with reperfusion ("reperfusion injury") is still under intense investigation regarding its nature and the strategy for its prevention. Reperfusion injury has been defined as cell injury caused by reperfusion itself, in contradistinction to cell injury caused by the...

BACKGROUND AND PURPOSE In a feasibility and safety study of thrombolytic therapy in acute ischemic stroke, we explored the usefulness of measurements of regional cerebral blood flow. METHODS Twenty-three patients with acute ischemic stroke were treated with 100 mg recombinant tissue plasminogen activator infused intravenously over 1 hour. Thrombolytic therapy was initiated 78 to 355 minutes a...

Sustained protection against ischemia-reperfusion injury is not available for patients at risk for myocardial infarction who may require emergent reperfusion therapy. Whereas ischemic preconditioning and adenosinergic agents reduce myocardial injury, they are only effective when given immediately before ischemia or reperfusion. We recently found chronic ethanol exposure, an adenosine uptake inh...

BACKGROUND Microvascular obstruction (MVO) describes suboptimal tissue perfusion despite restoration of infarct-related artery flow. There are scarce data on Infarct Size (IS) and MVO in relation to the mode and timing of reperfusion. We sought to characterise the prevalence and extent of microvascular injury and IS using Cardiovascular magnetic resonance (CMR), in relation to the mode of reper...

M ultiple, large randomised trials comparing primary percutaneous coronary intervention (PCI) with fibrinolytic therapy for ST elevation myocardial infarction (STEMI) have shown that primary PCI results in lower rates of death, reinfarction, and stroke. Consequently, primary PCI has become the preferred reperfusion strategy for STEMI. Unfortunately, primary PCI is available in only a minority o...

BACKGROUND Sex disparities in reperfusion therapy for patients with acute ST-segment-elevation myocardial infarction have been documented. However, little is known about whether these patterns exist in the comparison of young women with men. METHODS AND RESULTS We examined sex differences in rates, types of reperfusion therapy, and proportion of patients exceeding American Heart Association r...

Nearly two decades after clinical trials established that fibrinolytic therapy for acute myocardial infarction preserves left ventricular function and reduces mortality, there is evidence that mechanical reperfusion therapy is superior in reducing the rates of death, reinfarction, intracranial bleeding, reocclusion of the infarct-related artery, and recurrent ischemia. Initially introduced as a...