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Updated: Jun 23, 2026
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 27, 2013
Selection of patients with acute myocardial infarction for thrombolytic therapy
1University of Michigan Medical Center, Ann Arbor.
Insights
Thrombolytic therapy significantly reduces mortality in eligible myocardial infarction patients. Expanding eligibility criteria to include selected high-risk subgroups, like elderly patients or those presenting later, could further improve outcomes.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Thrombolytic therapy is a critical treatment for acute myocardial infarction.
- Current eligibility criteria for thrombolysis may limit its widespread application and benefit.
Purpose of the Study:
- To critically review current recommendations for thrombolytic therapy eligibility in myocardial infarction patients.
- To assess the impact of current exclusion criteria on patient outcomes.
Main Methods:
- Systematic review of randomized controlled trials and observational studies published between 1980 and 1990.
- Analysis of patient eligibility, reasons for exclusion, and clinical outcomes.
- Examination of exclusion criteria validity using subgroup analyses.
Main Results:
- Few myocardial infarction patients are currently eligible for thrombolysis, despite significant mortality reduction in treated groups.
- Patients excluded from thrombolysis experience high early mortality.
- Selected high-risk subgroups, including elderly patients, those presenting later than 6 hours, and patients with controlled hypertension, may benefit from expanded eligibility.
Conclusions:
- Optimizing thrombolytic therapy requires continuous evaluation and refinement of selection criteria.
- Identifying and treating a broader range of eligible patients is essential to fully realize the potential of thrombolysis in altering myocardial infarction outcomes.
Purpose:
To critically review the current recommendations regarding the eligibility of patients with myocardial infarction for thrombolytic therapy.
Data Identification:
Relevant studies published from January 1980 to January 1990 were identified through a computerized search of the English-language literature using MEDLINE and by a manual search of the bibliographies of all identified articles.
Study Selection:
All randomized, controlled trials of intravenous thrombolysis in acute myocardial infarction and unstable angina were reviewed. Smaller, observational studies and previous review articles were included when relevant to the discussion.
Data Extraction:
Key data were extracted from each article, including the proportions of patients eligible for thrombolysis, the reasons for exclusion from thrombolytic therapy, and the clinical outcomes of patients treated and of those excluded from treatment. The validity of certain exclusion criteria was examined using subgroup analysis from the large, randomized mortality trials of intravenous thrombolysis and observations from smaller, nonrandomized studies.
Results Of Data Synthesis:
To date, relatively few patients with myocardial infarction have been considered eligible for fibrinolytic therapy. In this group, both early and late mortality have been significantly reduced. Patients excluded from thrombolysis, however, continue to have a high early mortality. The data suggest that the potential benefits of this treatment might be extended to selected high-risk subgroups. In particular, the risk-benefit ratio may favor the inclusion of otherwise healthy elderly patients; certain patients presenting more than 6 hours after the onset of symptoms; and patients with a history of controlled systolic hypertension or brief, nontraumatic cardiopulmonary resuscitation. The data do not support the use of fibrinolytic therapy as primary treatment in patients with unstable angina or suspected myocardial infarction in the absence of confirmatory electrocardiographic changes.
Conclusions:
The full potential of thrombolytic therapy to alter the natural history of acute myocardial infarction can only be realized through the continued evaluation of selection criteria and the identification and treatment of the greatest possible number of eligible patients.
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