EDITORIAL No-reflow: the next challenge in treatment of ST-elevation acute myocardial infarction

This editorial refers to ‘Plasma levels of thromboxane A2 on admission are associated with no-reflow after primary percutaneous coronary intervention’ † by G. Niccoli et al., on page 1843 Coronary revascularization is not synonymous with myocardial reperfusion. DeWood et al.1 almost three decades ago showed that 90 % of patients with transmural myocardial infarction had total coronary occlusion at angiography associated with acute thrombosis. This and other studies have paved the way for the use of fibrinolytics in the treatment of transmural or ST-segment elevation myocardial infarction (STEMI). Despite the clear benefits observed with fibrinolysis, a significant pro-portion of patients failed to achieve adequate reperfusion as wit-nessed by persistence of total coronary occlusion, slow epicardial flow at angiography, or failure of regression of other signs o