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Thrombolytic Therapy in Acute Myocardial Infarction

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Abstract

Early reperfusion of thrombotically occluded coronary arteries by thrombolytic therapy has become a routine option in initial therapy of acute myocardial infarction. Many efforts have been made to improve the biological properties of thrombolytic agents in terms of fibrin specificity, plasma half-life and resistance to natural plasma inhibitors, to improve adjuvant therapy and to shorten the ‘pain to reperfusion’ time. Numerous randomised, multicentre trials have analysed the benefit of the various thrombolytic agents and regimens, which has enabled the creation of a ‘current standard of therapy’.

This review presents an update on available thrombolytic agents, their biochemical and pharmacological properties and results from clinical trials.

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References

  1. Braunwald E. Unstable angina: an etiologic approach to management. Circulation 1998; 98: 2219–22

    Article  PubMed  CAS  Google Scholar 

  2. Reimer KA, Lowe JE, Rasnussen MM, et al. The wave front phenomenon of ischemic cell death: I. Myocardial infarct size vs duration of coronary occlusion in dogs. Circulation 1977; 56: 786–93

    Article  PubMed  CAS  Google Scholar 

  3. Cannon CP, Antman EM, Walls R, et al. Time as an adjunctive agent to thrombolytic therapy. J Thromb Thrombolys 1994; 1: 27–34

    Article  Google Scholar 

  4. Ross AM, Coyne KS, Moreyra E, et al. for the GUSTO-I Angiographic Investigators. Extended mortality benefit of early postinfarction reperfusion. Circulation 1998; 97: 1549–56

    Article  PubMed  CAS  Google Scholar 

  5. LATE Study Group. Late assessment of thrombolytic efficacy (LATE) study with alteplase 6–24 hours after onset of acute myocardial infarction. Lancet 1993; 342: 759–66

    Article  Google Scholar 

  6. Braunwald E. The open-artery theory is alive and well — again. N Engl J Med 1993; 329: 1650–2

    Article  PubMed  CAS  Google Scholar 

  7. Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHAguidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction. J Am Coll Cardiol 1996; 28(5): 1328–56

    Article  PubMed  CAS  Google Scholar 

  8. Smith SC, Gilpin E, Ahnve S. Outlook after acute myocardial infarction in the very elderly compared with that in patients aged 65 to 75 years. J Am Coll Cardiol 1990; 16: 784–92

    Article  PubMed  Google Scholar 

  9. Grines CL, DeMaria AN. Optimal utilization of thrombolytic therapy for acute myocardial infarction: concepts and controversies. J Am Coll Cardiol 1990; 16: 223–31

    Article  PubMed  CAS  Google Scholar 

  10. Rich MW, Bosner MS, Chung MK, et al. Is age an independent predictor of early and late mortality in patients with acute myocardial infarction? Am J Med 1992; 92: 7–13

    Article  PubMed  CAS  Google Scholar 

  11. Lesnevsky EJ, Lundergan CF, Hodgson J, et al. Increased left ventricular dysfunction in elderly patients despite successful thrombolysis: the GUSTO-1 angiographic experience. J Am Coll Cardiol 1996; 28: 331–7

    Article  Google Scholar 

  12. GUSTO Investigators: An international randomized trial comparing thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993; 329: 673–82

    Article  Google Scholar 

  13. Krumholz HM, Murillo JE, Chen J, et al. Thrombolytic therapy for eligible elderly patients with acute myocardial infarction. JAMA 1997; 277: 1683–8

    Article  PubMed  CAS  Google Scholar 

  14. Gurwitz JH, Goldberg RJ, Gore JM. Coronary thrombolysis for the elderly? JAMA 1991; 265: 1720–3

    Article  PubMed  CAS  Google Scholar 

  15. Fibrinolytic Therapy Trialists’ (FFT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients. Lancet 1994; 343: 311–22

    Google Scholar 

  16. Barbash GI, White HD, Modan M, et al., for the Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Significance of diabetes mellitus in patients with acute myocardial infarction receiving thrombolytic therapy. J Am Coll Cardiol 1993; 22: 707–13

    Article  PubMed  CAS  Google Scholar 

  17. Mahaffey KW, Granger CB, Toth CA, et al., for the GUSTO-I Investigators. Diabetic retinopathy should not be a contraindication to thrombolytic therapy for acute myocardial infarction: review of ocular hemorrhage incidence and location in the GUSTO-I trial. J Am Coll Cardiol 1997; 30: 1606–10

    Article  PubMed  CAS  Google Scholar 

  18. Woodfield SL, Lundergan CF, Reiner JS, et al., for the GUSTOI Angiographic Investigators. Angiographic findings and outcome in diabetic patients treated with thrombolytic therapy for acute myocardial infarction: the GUSTO-I experience. J Am Coll Cardiol 1996; 28: 1661–9

    Article  PubMed  CAS  Google Scholar 

  19. Karnash SL, Granger CB, White HD, et al., for the GUSTO-I Investigators. Treating menstruating women with thrombolytic therapy: insights from the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I) Trial. J Am Coll Cardiol 1995; 26: 1651–6

    Article  PubMed  CAS  Google Scholar 

  20. Neches RB, Goldfarb AM. Thrombolytic therapy after cardiopulmonary resuscitation in acute myocardial infarction. Am J Cardiol 1993; 71: 258–61

    Article  PubMed  CAS  Google Scholar 

  21. Scholz KH, Tebbe U, Herrmann C, et al. Frequency of complications of cardiopulmonary resuscitation after thrombolysis during acute myocardial infarction. Am J Cardiol 1992; 69: 724–8

    Article  PubMed  CAS  Google Scholar 

  22. Weston CFM, Avery P. Thrombolysis following pre-hospital cardiopulmonary resuscitation. Int J Cardiol 1992; 37: 195–8

    Article  PubMed  CAS  Google Scholar 

  23. Brogden RN, Speight TM, Avery GS. Streptokinase: a review of its clinical pharmacology, mechanism of action and therapeutic uses. Drugs 1973; 5: 357–445

    Article  PubMed  CAS  Google Scholar 

  24. Cederholm-Williams SA, de Cook F, Lijnen HR, et al. Kinetics of the reactions between streptokinase, plasmin and alpha-2 antiplasmin. Eur J Biochem 1979; 100: 125–52

    Article  PubMed  CAS  Google Scholar 

  25. Marder VJ, Sherry S. Thrombolytic therapy: current status. N Engl J Med 1988; 318: 1512–20

    Article  PubMed  CAS  Google Scholar 

  26. Aylward P, Wilcox R, Horgan J, et al. Relation of increased arterial blood pressure to mortality and stroke in the context of contemporary thrombolytic therapy for acute myocardial infarction: a randomized trial. GUSTO-I Investigators. Ann Intern Med 1996; 125(11): 891–900

    PubMed  CAS  Google Scholar 

  27. Smith RAG, Dupe RJ, English PD, et al. Fibrinolysis with acylenzymes: new approach to thrombolytic therapy. Nature 1981; 290: 505–8

    Article  PubMed  CAS  Google Scholar 

  28. European Myocardial Infarction Project Group. Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction. N Engl J Med 1993; 329: 383–9

    Article  Google Scholar 

  29. Rawles J. Halving of mortality at 1 year by domiciliary thrombolysis in the Grampian Region Early Anistreplase Trial (GREAT). J Am Coll Cardiol 1994; 23: 1–5

    Article  PubMed  CAS  Google Scholar 

  30. Wiman B, Wallén P. Structural relationship between “glutamic acid” and “lysine” forms of human plasminogen and their interaction with the NH2-terminal activation peptide as studied by affinity chromatography. Eur J Biochem 1975; 50: 489–94

    Article  PubMed  CAS  Google Scholar 

  31. ISIS-3 (Third International Study of Infarct Survival Collaborative Group). ISIS-3: a randomized comparison of streptokinase vs tissue plasminogen activator vs anistreplase and aspirin plus heparin vs aspirin alone among 41,299 cases of suspected myocardial infarction. Lancet 1992; 339: 753–40

    Article  Google Scholar 

  32. Neuhaus K-L, von Essen R, Tebbe U. Improved thrombolysis in acute myocardial infarction with front-loaded administration of alteplase: results of the rt-PA-APSAC patency study (TAPS). J Am Coll Cardiol 1992; 19: 885–9

    Article  PubMed  CAS  Google Scholar 

  33. Cannon CP, McCabe CH, Diver DJ, et al., and the TIMI 4 Investigators. Comparison of front-loaded recombinant tissue-type plasminogen activator, anistreplase and combination thrombolytic therapy for acute myocardial infarction: results of the thrombolysis in myocardial infarction (TIMI) 4 trial. J Am Coll Cardiol 1994; 24: 1602–10

    Article  PubMed  CAS  Google Scholar 

  34. Collen D, Silence K, Demarsin E, et al. Isolation and characterization of natural and recombinant staphylokinase. Fibrinolysis 1992; 6: 20313

    Google Scholar 

  35. Collen D. Staphylokinase: a potent, uniquely fibrin-selective thrombolytic agent. Nat Med 1998; 4(3): 279–84

    Article  PubMed  CAS  Google Scholar 

  36. Lijnen HR, van Hoef B, Vandenbossche L, et al. Biochemical properties of natural and recombinant staphylokinase. Fibrinolysis 1992; 6: 214–25

    Article  CAS  Google Scholar 

  37. Lijnen HR, van Hoef B, de Cock F, et al. On the mechanism of fibrin-specific plasminogen activation by staphylokinase. J Biol Chem 1991; 266: 11826–32

    PubMed  CAS  Google Scholar 

  38. Vanderschueren SMF, Lijnen HR, Collen D. Properties of staphylokinase and its potential as a thrombolytic agent. Fibrinolysis 1995; 9Suppl. 1: 87–90

    CAS  Google Scholar 

  39. Okada K, Lijnen HR, Moreau H, et al. Procoagulant properties of intravenous staphylokinase versus tissue-type plasminogen activator. Thromb Haemost 1996; 76: 857–9

    PubMed  CAS  Google Scholar 

  40. Collen D, Stassen J-M, Yasuda T, et al. Comparative thrombolytic properties of tissue-type plasminogen activator and of a plasminogen activator inhibitor-1 resistant glycosylation variant, in a combined arterial and venous thrombosis model in the dog. Thromb Haemost 1994; 72: 98–104

    PubMed  CAS  Google Scholar 

  41. Collen D. Engineered staphylokinase variants with reduced immunogenicity. Fibrinol Proteol 1998; 12Suppl. 2: 59–65

    Article  CAS  Google Scholar 

  42. Huber K. Biochemistry, pharmacokinetics and dynamics of single- and two-chain urokinase. In: Becker RC, editor. The textbook of coronary thrombosis and thrombolysis. Boston: Kluwer Academic Publishers, 1997: 247–55

    Chapter  Google Scholar 

  43. Collen D. On the regulation and control of fibrinolysis. Thromb Haemost 1980; 43: 77–89

    PubMed  CAS  Google Scholar 

  44. Günzler WA, Steffens GJ, Ötting F, et al. Structural relationship between human high and low molecular mass urokinase. Hoppe Seyler’s Z Physiol Chem 1982; 363: 133–41

    Article  PubMed  Google Scholar 

  45. Mathey DG, Schofer H, Sheehan FH, et al. Intravenous urokinase in acute myocardial infarction. Am J Cardiol 1985; 55: 878–82

    Article  PubMed  CAS  Google Scholar 

  46. Neuhaus K-L, Tebbe U, Gottwick M, et al. Intravenous recombinant tissue plasminogen activator (rt-PA) and urokinase in acute myocardial infarction: results of the German activator urokinase study (GAUS). J Am Coll Cardiol 1988; 12: 581–7

    Article  PubMed  CAS  Google Scholar 

  47. Pannell R, Gurewich V. Pro-urokinase: a study of its stability in plasma and of a mechanism of selective fibrinolytic effect. Blood 1986; 67: 1215–23

    PubMed  CAS  Google Scholar 

  48. Tebbe U, Windeler J, Boesl I, et al. Thrombolysis with recombinant unglycosylated single-chain urokinase-type plasminogen activator (saruplase) in acute myocardial infarction: influence of heparin on early patency rate (LIMITS Study). J Am Coll Cardiol 1995; 26: 365–73

    Article  PubMed  CAS  Google Scholar 

  49. PRIMI Trial Study Group. Randomized double-blind trial of recombinant prourokinase against streptokinase in acute myocardial infarction. Lancet 1989; I: 863–8

    Google Scholar 

  50. Michels R, Hoffmann H, Windeler J, et al. Adouble-blind multicenter comparison of the efficacy and safety of saruplase and urokinase in the treatment of acute myocardial infarction: report of the SUTAMI Study Group. J Thromb Thrombolys 1995; 2: 117–24

    Article  CAS  Google Scholar 

  51. Bär FW, Meyer J, Vermeer F, et al. Comparison of saruplase and alteplase in acute myocardial infarction: the Study in Europe with Saruplase and Alteplase in Myocardial Infarction (SESAM). Am J Cardiol 1997; 79: 727–32

    Article  PubMed  Google Scholar 

  52. Tebbe U, Michels R, Adgey J, et al. Randomized, double-blind study comparing saruplase with streptokinase therapy in acute myocardial infarction: the COMPASS equivalence trial. J Am Coll Cardiol 1998; 31: 487–93

    Article  PubMed  CAS  Google Scholar 

  53. Bär FW, Meyer J, Boland J, et al. Bolus administration of saruplase in Europe (BASE), a pilot study in patients with acute myocardial infarction. J Thromb Thrombolys 1998; 6: 147–53

    Article  Google Scholar 

  54. Gulba DC, Bode C, Runge MS, et al. Thrombolytic agents — an updated overview. Fibrinol Proteol 1998; 12: 39–58

    Article  CAS  Google Scholar 

  55. Rijken DC, Hoylarts M, Collen D. Fibrinolytic properties of one-chain and two-chain human extrinsic (tissue-type) plasminogen activator. J Biol Chem 1982; 257: 2920–6

    PubMed  CAS  Google Scholar 

  56. Bleich SD, Nichols TC, Schumacher RR, et al. Effect of heparin on coronary arterial patency after thrombolysis with tissue plasminogen activator in acute myocardial infarction. Am J Cardiol 1990; 66: 1412–7

    Article  PubMed  CAS  Google Scholar 

  57. Gulba DC, Tanswell P, Dechend R, et al. Sixty-minute alteplase protocol: a new accelerated recombinant tissue-type plasminogen activator regimen for thrombolysis in acute myocardial infarction. J Am Coll Cardiol 1997; 30: 1611–7

    Article  PubMed  CAS  Google Scholar 

  58. Martin U, Bader R, Böhm E, et al. BM 06.022: a novel recombinant plasminogen activator. Cardiovasc Drug Rev 1993; 11: 299–311

    Article  CAS  Google Scholar 

  59. Martin U, Fischer S, Sponer G. Influence of heparin and systemic lysis on coronary blood flow after reperfusion induced by novel recombinant plasminogen activator BM 06.022 in a canine model of coronary thrombosis. J Am Coll Cardiol 1993; 22: 914–20

    Article  PubMed  CAS  Google Scholar 

  60. International Joint Efficacy Comparison of Thrombolytics (INJECT). Randomized, double-blind comparison of reteplase double-bolus administration with streptokinase in acute myocardial infarction: trial to investigate equivalence. Lancet 1995; 346: 329–35

    Article  Google Scholar 

  61. TIMI Study Group. The Thrombolysis in Myocardial Infarction (TIMI) Trial: phase I findings. N Engl J Med 1985; 312: 932–6

    Google Scholar 

  62. Smalling RW, Bode C, Kalbfleisch J, et al., and the RAPID Investigators. More rapid, complete, and stable coronary thrombolysis with bolus administration of reteplase compared with alteplase infusion in acute myocardial infarction. Circulation 1995; 91: 2725–52

    Article  PubMed  CAS  Google Scholar 

  63. Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO III) Investigators. A comparison of reteplase with alteplase for acute myocardial infarction. N Engl J Med 1997; 337: 1118–23

    Article  Google Scholar 

  64. Larsen GR, Timony GA, Horgan PG, et al. Protein engineering of novel plasminogen activators with increased thrombolytic potency in rabbits relative to activase. J Biol Chem 1991; 266: 8156–61

    PubMed  CAS  Google Scholar 

  65. den Heijer P, Vermeer F, Ambrosioni E, et al. Evaluation of a weight-adjusted single bolus plasminogen activator in patients with myocardial infarction: a double-blind, randomized angiographic trial of lanoteplase versus alteplase. Circulation 1998; 98: 2117–25

    Article  Google Scholar 

  66. Neuhaus K-L. A phase III trial of a novel bolus thrombolytic lanoteplase (n-PA): intravenous n-PA for Treating Infarcting Myocardium Early (In-TIME)-II [oral presentation]. Annual Meeting of the American College of Cardiology: 1999 March; New Orleans

  67. Paoni NF, Keyt BA, Refino CJ, et al. A slow clearing, fibrinspecific PAI-1 resistant variant of t-PA (T103N, KHRR 296–299 AAAA). Thromb Haemost 1993; 70: 307–12

    PubMed  CAS  Google Scholar 

  68. Refino CJ, Keyt BA, Paoni NF, et al. A variant of tissue plasminogen activator (t103N, N117Q, KHRR 296–299 AAAA) with a decreased plasma clearance rate is substantially more potent than Activase TM rt-PA in a rabbit thrombolysis model. Thromb Haemost 1983; 52: 841–5

    Google Scholar 

  69. Van de Werf F, Cannon C, Luyten A, et al. Safety assessment of single-bolus administration of TNK tissue plasminogen activator in acute myocardial infarction: the ASSENT-1 trial: the ASSENT-1 Investigators. Am Heart J 1999; 137(5): 786–91

    Article  PubMed  Google Scholar 

  70. Cannon C, Gibson C, McCabe C, et al. TNK-tissue plasminogen activator compared with front-loaded alteplase in acute myocardial infarction: results of the TIMI 10B trial. Thrombolysis in Myocardial Infarction (TIMI) 10B Investigators. Circulation 1998; 98(25): 2805–14

    Article  PubMed  CAS  Google Scholar 

  71. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial: assessment of the Safety and Efficacy of a New Thrombolytic Investigators. Lancet 1999; 354: 716–22

  72. Gulba DC, Praus M, Witt W. DSPA alpha — properties of the plasminogen activators of the vampire bat desmodus rotundus. Fibrinolysis 1995; 9Suppl. 1: 91–6

    CAS  Google Scholar 

  73. Huber K, Nikfardjam M, Christ G, et al. Acute coronary syndromes: recent achievements and future aspects. Fibrinol Proteol 1998; 12Suppl. 2: 67–89

    Article  CAS  Google Scholar 

  74. Seitz R, Blanke H, Prätorius G, et al. Increased thrombin activity during thrombolysis. Thromb Haemost 1988; 1988: 541–2

    Google Scholar 

  75. Young E, Prins MH, Levine MN, et al. Heparin binding to plasma proteins: an important mechanism for heparin resistance. Thromb Haemost 1992; 67: 639–42

    PubMed  CAS  Google Scholar 

  76. O’Connor CM, Meese R, Carney R, et al., for the DUCCS Group. A randomized trial of intravenous heparin in conjunction with anistreplase (anisoylated plasminogen streptokinase activator complex) in acute myocardial infarction: the Duke University Clinical Cardiology Study (DUCCS) 1. J Am Coll Cardiol 1994; 23: 11–8

    Article  PubMed  Google Scholar 

  77. Kontny F, Dale J, Abilgaard U, et al. Randomized trial of low molecular weight heparin (dalteparin) in prevention of left ventricular thrombus formation and arterial embolism after anterior myocardial infarction: the Fragmin in Acute Myocardial Infarction (FRAMI) study. J Am Coll Cardiol 1997; 30: 962–9

    Article  PubMed  CAS  Google Scholar 

  78. Glick A, Kornowski R, Michowich Y, et al. Reduction of reinfarction and angina with use of low-molecular-weight heparin therapy after streptokinase (and heparin) in acute myocardial infarction. Am J Cardiol 1996; 77: 1145–8

    Article  PubMed  CAS  Google Scholar 

  79. Antman EM, for the TIMI 9A Investigators. Hirudin in acute myocardial infarction: safety report from the Thrombolysis and Thrombin Inhibition in Myocardial Infarction (TIMI) 9A trial. Circulation 1994; 90: 1624–30

    Article  PubMed  CAS  Google Scholar 

  80. GUSTO IIa Investigators. Randomized trial of intravenous heparin versus recombinant hirudin for acute coronary syndromes. The Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) IIa Investigators. Circulation 1994; 90: 1631–2

    Article  Google Scholar 

  81. Neuhaus K-L, Von Essen R, Tebbe U, et al. Safety observations from the pilot phase of the randomised r-Hirudin for Improvement of Thrombolysis (HIT-III) Study: a study of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausarzte (ALKK). Circulation 1994; 90: 1638–42

    Article  PubMed  CAS  Google Scholar 

  82. Antman EM, for the TIMI 9B Investigators. Hirudin in acute myocardial infarction. Thrombolysis and Thrombin Inhibition in Myocardial Infarction (TIMI) 9B Trial. Circulation 1996; 94: 911–21

    Article  PubMed  CAS  Google Scholar 

  83. GUSTO IIb Investigators. Acomparison of recombinant hirudin with heparin for the treatment of acute coronary syndromes. N Engl J Med 1996; 335: 775–82

    Article  Google Scholar 

  84. Simes R, Granger C, Antman E, et al. Impact of hirudin versus heparin on mortality and (re)infarction in patients with acute coronary syndromes: a prospective meta-analysis of the GUSTO IIb and TIMI 9b trials. Circulation 1996; 94Suppl. I: I–430

    Google Scholar 

  85. ISIS-2 Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988; 2: 349–60

    Google Scholar 

  86. Gulba DC, Huber K, Moll S, et al. Platelet inhibition: new agents, new strategies, new trials. Fibrinol Proteol 1998; 12Suppl. 2: 13–23

    Article  CAS  Google Scholar 

  87. Coller BS. Platelet GP IIb/IIIa antagonists: the first anti-integrin receptor therapeutics. J Clin Invest 1997; 99: 1467–71

    Article  PubMed  CAS  Google Scholar 

  88. Ohman EM, Lincoff AM, Bode C, et al. Enhanced early reperfusion at 60 minutes with low-dose reteplase combined with full-dose abciximab in acute myocardial infarction: preliminary results from the GUSTO-IV (SPEED) dose-ranging trial. Circulation 1998 Oct 21; 98 Suppl.: 504

    Google Scholar 

  89. Antman EM, Giugliano RP, Gibson M, et al. for the TIMI 14 Investigators. Abciximab facilitates the rate and extent of thrombolysis: results of the Thrombolysis In Myocardial Infarction (TIMI) 14 Trial. Circulation 1999; 99: 2720–32

    Article  PubMed  CAS  Google Scholar 

  90. Ohman M, Kleiman N, Gacioch G, et al. for the IMPACT-AMI Investigators. Combined accelerated tissue-plasminogen activator and platelet glycoprotein IIb/IIIa integrin receptor blockade with integrilin in acute myocardial infarction: results of a randomized, placebo-controlled dose-ranging trial. Circulation 1997; 95: 846–54

    Article  PubMed  CAS  Google Scholar 

  91. MacCallum AG, Stafford PJ, Jones C, et al. Reduction in hospital time to thrombolytic therapy by audit of policy guidelines. Eur Heart J 1990; 11Suppl. F: 48–52

    Article  PubMed  Google Scholar 

  92. Herlitz J, Hartford M, Blohm M, et al. Effect of a media campaign on delay times and ambulance use in suspected acute myocardial infarction. Am J Cardiol 1989; 64: 90–3

    Article  PubMed  CAS  Google Scholar 

  93. White HD, Van de Werf F. Thrombolysis for acute myocardial infarction. Circulation 1998; 97: 1632–46

    Article  PubMed  CAS  Google Scholar 

  94. GUSTO Angiographic Investigators: the effects of tissue plasminogen activator, streptokinase, or both on coronary artery patency, ventricular function, and survival after myocardial infarction. N Engl J Med 1993; 329: 1615–22

    Google Scholar 

  95. Lincoff AM, Topol EJ. Trickle down thrombolysis. J Am Coll Cardiol 1993; 21: 1396–8

    Article  PubMed  CAS  Google Scholar 

  96. Every NR, Parsons LS, Hlatky M, et al. Acomparison of thrombolytic therapy with primary coronary angioplasty for acute myocardial infarction. N Engl J Med 1996; 335: 1253–61

    Article  PubMed  CAS  Google Scholar 

  97. Gibbons RJ, Holmes DR, Reeder GS, et al. Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. N Engl J Med 1993; 328: 685–91

    Article  PubMed  CAS  Google Scholar 

  98. Grines CL, Browne KF, Marco J, et al. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1993; 328: 673–79

    Article  PubMed  CAS  Google Scholar 

  99. Ribeiro EE, Silva LA, Carneiro R, et al. Randomized trial of direct coronary angioplasty versus intravenous streptokinase in acute myocardial infarction. J Am Coll Cardiol 1993; 22: 376–80

    Article  PubMed  CAS  Google Scholar 

  100. Stone GW, Grines CL, Browne KF, et al. Predictors of in-hospital and 6-months outcome after acute myocardial infarction in the reperfusion era: the Primary Angioplasty in Myocardial Infarction (PAMI) Trial. J Am Coll Cardiol 1995; 25: 370–3

    Article  PubMed  CAS  Google Scholar 

  101. Zijlstra F, de Boer MJ, Hoorntje JC, et al. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med 1993; 328: 680–4

    Article  PubMed  CAS  Google Scholar 

  102. Brener S, Barr LA, Burchenal JEB, et al. Randomized, placebo-controlled trial of platelet glycoprotein IIb/IIIa blockade with primary angioplasty for acute myocardial infarction. Circulation 1998; 98: 734–41

    Article  PubMed  CAS  Google Scholar 

  103. Ross AM, Coyne KS, Reiner JS et al. A randomised trial comparing primary angioplasty with a strategy of short-acting thrombolysis and immediate planned rescue angioplasty in acute myocardial infarction: the PACT trial. J Am Coll Cardiol 1999; 34: 1954–62

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Cardiology, University of Vienna Medical School, Waehringer Guertel 18–20, A-1090, Vienna, Austria

    Ute Priglinger &  Kurt Huber

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Priglinger, U., Huber, K. Thrombolytic Therapy in Acute Myocardial Infarction. Drugs & Aging 16, 301–312 (2000). https://doi.org/10.2165/00002512-200016040-00006

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