[Thrombolytic treatment during the acute phase of myocardial infarction. An important reduction of early and secondary mortality]

Abstract

After a number of disorganised trials of intravenous thrombolysis in the acute phase of myocardial infarction in the early 1970s, the idea was abandoned for nearly a decade. However, from the beginning of the 1980s a convergence of anatomical data, improved understanding of the mechanisms of thrombosis and of thrombolytic agents, and technical advances in the practice of coronary angiography led to the introduction of intracoronary thrombolysis. Analysis of the preliminary trials demonstrated the efficacy of thrombolytic therapy, first of all with Streptokinase, in recanalizing coronary arteries in the first hours of myocardial infarction. Larger series, especially one from Holland, showed a limitation of infarct size and a consequent reduction in hospital and 1 year mortality (5% versus 9.8% and 8.5% versus 16% respectively). Intravenous thrombolysis rapidly took over from intracoronary administration and the simplification of treatment facilitated the popularization of the method and the realisation of large scale clinical trials including thousands of patients. Comparisons with conventional therapy were performed in 6 large international trials ISAM, GISSI, ISIS 2, AIMS, ASSET and 5th European Cooperative Trial) using Streptokinase or second generation thrombolytics (APSAC and rt-PA). All showed a significant decrease in early mortality with thrombolytic therapy in the acute phase of myocardial infarction but with large variations (from 11% to 51%). These results helped to generalize the use of thrombolytic agents in the first hours of myocardial infarction. Advances in scientific research and methodology then allowed the last trials to be set up to compare thrombolytic agents and determine the most effective and the least dangerous.(ABSTRACT TRUNCATED AT 250 WORDS)