Coronary thrombolysis with tissue-type plasminogen activator

Although the value of reperfusion has not yet been convincingly established in humans, initial data with precise end points appear to indicate salutary effects. t-PA will have a clear role in the initial phase of treatment of myocardial infarction, but it must be administered promptly, and residual stenosis must be evaluated and treated if reocclusion is to be prevented. Optimum therapy may involve concomitant pharmacologic agents as well as mechanical or surgical intervention. Long-term goals must address the underlying pathophysiology of coronary atheromata formation and thrombogenesis and primary prevention.