[New thrombolytic agents. Effect on the organization of care in myocardial infarction]

In the last few years, intravenous thrombolysis has widely become the treatment of reference in the acute phase of myocardial infarction. Among the new thrombolytic agents which are currently being evaluated, two are particularly ahead of the group: 1) the plasminogen tissue activator, known at this time for a revascularizing effect exceeding that of streptokinase for a lesser fibrinogenolytic activity; its effectiveness in terms of mortality remains to be defined; 2) the acyl-streptokinase presents the advantage over the classic streptokinase of being injected in one single injection of 5 minutes. The revascularizing activity of this product seems to exceed that of streptokinase, and the fibrinolytic activity is the same as streptokinase's. The effectiveness in terms of mortality remains to be evaluated. The better effectiveness of the new thrombolytic agents should not let us forget that the main problem is to organize patient's care and that improvement of the effectiveness of thrombolytic therapy is mainly obtained through improvement of the screening and an early diagnosis of myocardial infarctions. Organization or patient's care in central hospitals and at the level of emergency transportation services will perhaps enable, in the years to come, to increase a great deal the number of patients who can benefit from thrombolysis and thus to decrease hospital and post-hospital mortality of myocardial infarction.