Thrombolytic therapy: The treatment of choice in acute myocardial infarction

The benefits in thrombolytic therapy have been unequivocally demonstrated by several major trials, with an overall decrease in mortality of 27% when these agents are administered during the first 6 hours of symptom onset. Although significant limitations in current regimens exist, thrombolytic therapy continues to be the treatment of choice in the vast majority of patients. Primary PTCA may be the preferred strategy in a select group of patients, given the availability of experienced operators and provided that initiation of mechanical reperfusion is not delayed. The field of treatment of AMI is rapidly evolving. The pharmacologic approach continues to improve with the development of new generations of thrombolytic agents and the addition of adjunctive therapies such as the glycoprotein IIb/IIIa antagonists. The mechanical approach also is under rapid evolution, with the use of stents to limit reocclusion and long-term restenosis, as well as the adjunctive use of pharmacologic agents. Irrespective of which strategy is used in the treatment of an evolving myocardial infarction, early restoration of complete infarct artery perfusion should be the essential therapeutic goal.