Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction.
Level 4 - case-series / case-control
Observational angiographic case series
PubMed 7412821 · doi:10.1056/NEJM198010163031601
What was done
Coronary arteriography was performed in 322 patients admitted within 24 hours of transmural myocardial infarction to assess coronary obstruction. In subsets of patients with (n = 59) and without (n = 20) angiographic features of thrombosis, thrombus presence was evaluated by retrieval with a Fogarty catheter.
What was found
Total coronary occlusion was present in 110 of 126 patients (87%) studied within 4 hours of symptom onset, decreasing significantly to 37 of 57 patients (65%) studied 12 to 24 hours after onset. Thrombus was retrieved by Fogarty catheter in 52 of 59 patients (88%) with angiographic signs of thrombosis (12% false-positive rate) and in 5 of 20 patients (25%) lacking angiographic features of thrombosis (25% false-negative rate).
Why it matters
This landmark paper demonstrated that acute transmural myocardial infarction is predominantly characterized by total thrombotic coronary occlusion in its earliest hours, establishing the foundation for emergent reperfusion therapy.
Limits
Single-center observational case series with no control group. The abstract does not specify data for the 4-to-12-hour interval, detailed patient selection criteria, or clinical outcomes.
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