Myocardial infarction: rationale for therapy in 1989.

The rationale for the therapy of acute myocardial infarction is logically based upon recognition of the etiologic role of acute thrombosis; hence the primary therapeutic goal is to restore coronary artery patency (and subsequently to preserve that patency). Multiple thrombolytic drugs are variably successful in accomplishing that objective as, in special circumstances, are acute mechanical interventions. After reperfusion, additional strategies are advocated both to preserve patency and to enhance the benefit of reperfusion. The state of our current understanding has been achieved through a productive combination of individual observations and inventiveness as well as painstaking clinical trials. While the major questions now appear to have satisfactory answers, numerous secondary questions have been generated in an effort to further refine the therapeutic algorithms as well as possibly expand the indications to a wider cohort of patients than have been traditionally treated and/or studied to date.