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Melvin D. Cheitlin, MD

JAMA. 1988;260(19):2894-2896.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Evolution in the treatment of patients with acute myocardial infarction has taken us, within a brief period of less than 40 years, from impotent observation to aggressive invasive intervention designed to open suddenly occluded coronary arteries. The attack on the patient with acute myocardial infarction, requiring sophisticated catheterization facilities and personnel immediately available at all times, takes on many of the attributes of battlefield evacuation, complete with helicopters and pseudo-MASH units. The concept that led to this approach was the resuscitation of the idea that thrombus over a plaque was the most important mechanism of sudden obstruction in transmural myocardial infarction. Chazov et al¹ in the Soviet Union were the first to demonstrate fibrinolysis by intracoronary streptokinase. Rentrop et al² stimulated general interest in intracoronary thrombolysis. Later, Schroder et al³ demonstrated that the occluded coronary artery could be opened by intravenous streptokinase.

The first randomized, controlled study . . . [Full Text PDF of this Article]

Author Affiliations
University of California, San Francisco San Francisco General Hospital

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