[Problems appearing after pharmacologic thrombolysis in acute myocardial infarct]

Pharmacologic myocardial reperfusion is a new strategy in the treatment of acute myocardial infarction, but its widespread use has raised several problems which are still unsolved. The time limit from the onset of ischemic pain until the beginning of thrombolysis is undefined yet. Experimental and clinical observations set this time within three hours. A reopened vessel is still at risk for reocclusion and anticoagulants are not always effective in the prevention of this. It is likely therefore that pharmacologic thrombolysis is only one step in the process of myocardial salvage and that other techniques like transluminal coronary angioplasty and/or coronary bypass surgery, should follow shortly. Intracoronary thrombolysis does not carry an increased risk for acute myocardial infarction patients. However haemorrhagic complications are expected to occur in less than 6% of cases during their hospital stay. To evaluate the extent of myocardial salvage quantitative ventriculography and intracoronary thallium 201 scintigraphy represent the most reliable techniques. Only the results of the continuing randomized trials will clarify the efficacy of this new way of therapy for morbidity, mortality and myocardial salvage.