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July 1988

Beyond Coronary Thrombolysis

Arch Intern Med. 1988;148(7):1503-1507. doi:10.1001/archinte.1988.00380070021006

Coronary heart disease, the leading cause of death in the United States, is responsible for 500 000 deaths annually. Furthermore, 5 to 6 million individuals in this country suffer from symptomatic coronary disease, with the potential to sustain an acute myocardial infarction (AMI). Pump failure is the most common cause of death following AMI and is determined by the extent of myocardial necrosis. Therefore, methods to limit infarct size have been vigorously sought.

The pathogenesis of AMI in general and the contributory role of intracoronary thrombosis in particular have been debated for decades. However, the work of DeWood et al,1 performing coronary angiography during the early stages of AMI, has established an occlusive thrombus as the primary event in transmural myocardial infarction. Having recognized this important fact, attention quickly turned to interventional therapies designed to remove intracoronary thrombus, thereby restoring myocardial blood flow.2,3 Early investigations utilizing clot lysing

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