[Thrombolysis of myocardial infarction--state of the art]

Thrombolytic therapy has revolutionized the treatment of acute myocardial infarction by reducing mortality and preserving left ventricular function. It is a relatively safe and cost-effective therapy, although underused in many countries. To further improve the results and the availability of this therapy, the reduction of the door-to-needle time in hospitals is the most important strategy. Alternatively, prehospital thrombolytic therapy has been shown to be feasible and to result in a similar risk reduction as thrombolytic therapy started in hospitals. In this overview the results of recent studies are summarized and discussed in view of defining indications more appropriately. Our current knowledge of adjunctive therapy is summarized briefly, and the benefits, risks and costs of thrombolytic therapy are presented. Interventional procedures are emphasized for treatment of patients with cardiogenic shock and unstable angina. Besides emergency and rescue PTCA, interventional therapy is an attractive and superior alternative to thrombolytic therapy. However, the results of interventional strategies depend largely on the operators and institutional experience and structural facilities, which are limited to a small number of institutions. Thus, any attempt has to be undertaken to provide thrombolytic therapy as early as possible to a patient population as large as possible.