0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Commentary |

Medical Reversal, Clinical Trials, and the “Late” Open Artery Hypothesis in Acute Myocardial Infarction:  Comment on “Impact of National Clinical Guideline Recommendations for Revascularization of Persistently Occluded Infarct-Related Arteries on Clinical Practice in the United States”

Mauro Moscucci, MD, MBA
Arch Intern Med. 2011;171(18):1643-1644. doi:10.1001/archinternmed.2011.299.
Text Size: A A A
Published online

Extract

Since the initial reports of a beneficial effect of reperfusion therapy in the management of acute myocardial infarction (MI), the open artery hypothesis and the benefits of timely reperfusion have been confirmed in numerous clinical trials investigating either pharmacological or mechanical reperfusion with percutaneous coronary intervention (PCI). Clinical trials have shown the importance of time to reperfusion. However, while the “early” open artery hypothesis has been consistently confirmed, the “late” open artery hypothesis (ie, reperfusion of an occluded infarct-related artery at a time too late for myocardial salvage and in patients without continuous symptoms) has been controversial for years. The rationale is that patency of the infarct vessel can improve left ventricular systolic function, and prevent ventricular remodeling and the late development of arrhythmias. It is important to note that, while late reperfusion with thrombolytic therapy has been found to be potentially harmful because it is associated with the added risk of myocardial rupture, with PCI, neither harm nor any definitive benefit has been reported in limited registry-based analysis and small clinical trials.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Acute Myocardial Infarction

brightcove.createExperiences();