Abstract
Between 1977 and 1980, our group performed immediate coronary angiography in 158 patients admitted with acute myocardial infarction (MI) at the University of Goettinger, Germany. From June 1978 to May 1979, our pioneering study of mechanical transcatheter recanalization of acute total coronary artery occlusions using guidewires and tapered catheters was performed. Restoration of antegrade flow in 7 of 13 patients was associated with an improvement in left ventricular function not seen in historical controls. From June 1979 to December 1980, the pathogenetic role of thrombus and spasm in acute coronary syndromes was explored in our pioneering study of intracoronary streptokinase infusion. Following injection of nitroglycerin, streptokinase was selectively infused at a rate of 2000 U/minute for 50–95 minutes. Only four of the initial 22 infarct patients showed improvement of antegrade flow following intracoronary nitroglycerin alone. Reopening of the completely obstructed vessel or increase in lumen diameter at the site of subtotal occlusion occurred in 22 of 29 infarct patients within 15–90 minutes of streptokinase infusion but in none of the five patients with unstable angina. Chest pain was alleviated and left ventricular function was improved significantly after successful lysis. The first presentation of both our mechanical and pharmacological interventions in acute MI to a large international audience at the annual American Heart Association meeting in 1979 convinced clinicians of the etiologic role of fibrin‐rich coronary thrombus in acute MI. The demonstration of rapid restoration of antegrade flow initiated a worldwide renaissance in the application of thrombolytic therapy and paved the way for primary angioplasty in acute MI.
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