Thrombolytic reperfusion of acute myocardial infarction: resolved and unresolved issues

Intensive clinical investigation has led to the acceptance of many fundamental aspects of reperfusion therapy, especially its salutary effects on improved survival, left ventricular function and reduced infarct size. However, many unresolved issues are currently being addressed or will be the focus of future clinical trials. These include patient selection with respect to risk profile and time of presentation, the choice of a thrombolytic agent, the role of adjunctive therapies and the optimal use and timing of follow-up coronary revascularization procedures. The rapidly evolving status of myocardial reperfusion therapy is reviewed, with specific attention to these important yet unresolved aspects.