[Thrombolysis in ST-elevation myocardial infarction. Current role in the light of recent studies]

As acute percutaneous interventions are only performed in about 20% of patients in Germany, thrombolysis will continue to play an essential role in the treatment of ST-elevation infarction. There is no real alternative to thrombolysis in hospitals without catheter facilities or with long transport times, especially for patients with a short duration of symptoms. Prehospital thrombolysis is widely underused despite its proven efficacy and safety. This is especially the case with respect to mortality of patients with symptoms <3 h, where thrombolysis seems to be at least as effective as or even superior to percutaneous coronary intervention (PCI) with respect to mortality (most probably by avoiding cardiogenic shock). "Facilitated PCI", i.e. thrombolysis +/-Gp IIb/IIIa receptor blocker and consecutive routine PCI is attractive and may be an option for the future. However, the logistic burden and problems of availability of EMS have not yet been investigated. Also, the principal value of "rescue PCI"still needs to be clarified. Moreover, defining simple clinical parameters which help to detect ineffective thrombolysis as well as time windows for detection and consecutive rescue intervention are urgent tasks for the near future. In order to guarantee an optimized and individualized therapy for the patient with acute myocardial infarction, peripheral hospitals, intervention centres and emergency medical services should set up networks, which consider the local resources, time lines and the specific conditions of the patient.