The open-artery hypothesis revisited.

A cute myocardial infarction (AMI) continues to be a major public health problem in the United States and other industrialized countries. According A to the American Heart Association, 13.2 million Americans have coronary disease, including 7.2 million with previous AMI. In 200 1, approximately 233 thousand people died of an AMI. Since the early 1980s, the development of pharmacological and mechanical reperfusion therapies has helped reduce mortality rates by allowing rapid, complete, and sustained restoration of coronary blood flow. This is in keeping with the "open-artery" hypothesis first proposed by Eugene Braunwald in 1989,(2) when he noted that patients with spontaneous recanalization of an infarct-related artery (IRA) had fewer adverse events during the following weeks and months. He observed that the difference in outcomes was not likely to be attributable to the small benefit in infarct salvage, because of the nearly identical left ventricular ejection fractions (LVEFs). Research on the benefits of the open artery, such as improved healing and electrical stabilization, has been inconclusive. This uncertainty has resulted in widespread inconsistencies of beliefs among cardiologists regarding the benefits of recanalization and, more specifically, the best time to recanalize. The development of groundbreaking reperfusion therapies, such as drug-eluting stents, makes a review of the data essential to expose the gaps in the research concerning the open artery. Herein, we present a critical evaluation of the available data and of the need for further research in this field.