Thrombolysis in Acute Myocardial Infarction

Abstract

There is by now a consensus that thrombolytic treatment in the first hours after the acute symptoms of myocardial infarction is reducing short-term and 1-year mortality. The evidence is based mainly on the Italian GISSI trial, the results of the ISIS-2 study and data pooled from other, smaller trials with intracoronary and intravenous streptokinase. The reduction in mortality is 15%–20% in patients treated with thrombolytic drugs within the first 5 h. During this period not only is coronary reperfusion more readily and rapidly achieved (the fresher. the thrombus, the faster the lysis), but there is also the critical time for reperfusion to salvage of myocardium (“time is muscle”). For the patient having continuing ischemia (as shown by continuing ischemic pain or by electrocardiographic changes), benefit may extend beyond this time. Efforts to reduce the time delay from the onset of symptoms to the institution of thrombolytic therapy, such as giving these agents in the patient’s home or in the coronary ambulance, are likely to have a major impact on survival.