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From the Coronary Care and Cardiovascular Research Units, Green Lane
Hospital, Auckland, New Zealand, and the Department of Cardiology, University
Hospital Gasthuisberg, Leuven, Belgium.
Correspondence to Professor Harvey White, Cardiology Department, Green Lane Hospital, Private Bag 92 189, Auckland 1030, New Zealand () or Professor Frans Van de Werf, Department of Cardiology, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium () e-mail frans.vandewerf{at}vz.kuleuven.ac.be
Abstract
Abstract—Thrombolytic
therapy has been a major advance in the management of acute myocardial
infarction. Unfortunately, it continues to be underused or is
administered later than is optimal. Thrombolytic therapy
works by lysing infarct artery thrombi and achieving reperfusion,
thereby reducing infarct size, preserving left ventricular
function, and improving survival. The most effective
thrombolytic regimens achieve angiographic epicardial
infarct-artery patency in only
© 1998 American Heart Association, Inc.
Clinical Cardiology: New Frontiers
Thrombolysis for Acute Myocardial Infarction
50% of patients within 90 minutes.
Bleeding requiring transfusion occurs in 5% of patients and stroke
in 1.8% with these regimens, which include adjunctive aspirin and
intravenous heparin. There are several ways in which
reperfusion rates and thus patient outcomes might be improved, such as
different dosing regimens of established agents; combinations of
different agents; improved adjunctive therapy such as direct
antithrombin agents, low-molecular-weight heparin, or
glycoprotein IIb/IIIa receptor antagonists; or
the development of novel thrombolytic agents with
enhanced fibrin specificity, resistance to native
inhibitors, or prolonged half-lives allowing bolus
administration. All of these strategies are being tested in clinical
trials. The best approach currently is to administer
thrombolytic therapy as soon as possible to all
patients without contraindications who present within 12 hours of
symptom onset and have ST-segment elevation on the ECG or new-onset
left bundle-branch block, unless an alternative reperfusion strategy
is planned.
Key Words: myocardial infarction • plasminogen activators • streptokinase • thrombolysis
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