[Thrombolytic therapy in fresh myocardial infarct]

In this overview the characteristics have been defined of those patients with acute myocardial infarction to whom early thrombolytic therapy would offer a major benefit. However, this concerns only the 20% of all patients who are admitted to the hospital with acute myocardial infarction within the specified time limit. It is still unclear whether later thrombolytic therapy with the newer agents might offer benefit to other patients with acute myocardial infarction. Presently, it seems unlikely that patients admitted to the hospital more than six hours after onset of symptoms will benefit from any reperfusion strategy. Patients admitted up to 24 hours after onset of symptoms with symptomatic and extensive ischemia (usually located anteriorly) or with signs of cardiogenic shock constitute a group of high risk patients who might derive further benefit from late reperfusion (42). It is likely that in the near future the new generation of thrombolytic agents (rt-PA, rscu-PA and APSAC) will become first choice for the intravenous initiation of thrombolytic therapy. Then, the indications for either acute or delayed angiography might be different from the present ones. Further cost/benefit analysis will certainly be required to assess the additional value of intracoronary thrombolysis and coronary angioplasty after intravenous administration of rt-PA, rscu-PA or APSAC. The required capacity of catheterization laboratories and facilities for coronary angioplasty and bypass surgery will depend on the results of those analyses.(ABSTRACT TRUNCATED AT 250 WORDS)