Reperfusion therapy for acute myocardial infarction: historical context and future promise

Reperfusion therapy for acute myocardial infarction is a milestone achievement in 20th century cardiology. This article tracks this therapy from the discovery that coronary thrombosis is the cause of myocardial infarction, through the pre-clinical era when studies in dogs demonstrated the benefit of early reperfusion. Then came early clinical observations in the feasibility of coronary thrombolysis in patients, followed by the early placebo-controlled megatrials (GISSI-I and ISIS-2), which showed a substantial mortality benefit. During the past decade there have been important refinements using ambulance-based therapy, new bolus thrombolytics, adjunctive glycoprotein inhibitors and percutaneous coronary intervention.