[The state of thrombolytic therapy in acute myocardial infarct]

Abstract

Current experience indicates that intravenous and intracoronary thrombolysis may prove promising in improving the prognosis of acute myocardial infarction. However, because of methodological shortcomings such as insufficient numbers of patients and retarded initiation of therapy no such improvement has been documented so far. According to findings in patients and corresponding results of experimental studies, a significant improvement in myocardial function and reduction in mortality can be achieved only when reperfusion occurs within 3 hours after onset of ischaemia. With later reperfusion the results are uncertain and benefit and damage may balance each other. Recanalization of occluded coronary arteries is achieved faster and more frequently with intracoronary than with intravenous administration of streptokinase but this advantage is often offset by the loss of time before intracoronary treatment is started. Methods, technique and complications of thrombolytic therapy, as well as further management of patients are discussed. Attention is drawn to newer activators of plasminogen which are claimed to be more effective despite lesser influence on coagulation.