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March 25, 1983

Emergency Revascularization-Reply

Author Affiliations

Des Moines

JAMA. 1983;249(12):1564. doi:10.1001/jama.1983.03330360017012

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In Reply.—  From 1975, until the advent of streptokinase and percutaneous transluminal coronary angioplasty, our only means for coronary reperfusion during evolving MI was direct revascularization. Since the advent of streptokinase and percutaneous transluminal coronary angioplasty, alternate means have become available. If these alternate means are successful—and in our experience they have been in a large percentage of the cases—then we see no need to invade the patients surgically, as suggested by Dr Reid in his letter. We also state unequivocally in our manuscript that if adequate reperfusion by nonsurgical means is unsuccessful (single-vessel disease) with streptokinase alone or combined with percutaneous transluminal coronary angioplasty, then immediate surgery is carried out. We certainly agree with Dr Reid that single coronary artery occlusion can be catastrophically fatal, and either our article did not state it strongly enough or he misread the fact that reperfusion is our therapeutic end point and goal.