Thrombolytic agents in early myocardial infarction

The current revolution in the treatment of acute myocardial infarction by means of thrombolytic therapy has as its underlying strategy 3 aims: early restoration of the blood flow in order to salvage jeopardized but still viable tissues, limitation of the ultimate infarct size, and preservation, as far as possible, of ventricular function. The hope is that these 3 achievements will result in reduced short- and long-term mortality rates. The techniques used in this overall strategy are still under investigation. Three leading pharmacologic compounds vie for supremacy: streptokinase as well as its anisoylated form, recombinant technique tissue-type plasminogen activator and urokinase with or without prourokinase. In addition, the underlying anatomy may require early, or delayed, percutaneous transluminal coronary angioplasty where needed backed by coronary artery bypass grafting. Thus, the tactics of the intervention may vary from case to case and indeed from center to center depending on experience and facilities, but the conclusion is clearly the same: Early reperfusion is a must if one wishes to save ischemic but viable tissue. This report summarizes the current evidence for this new strategy.