[Thrombolysis in acute myocardial infarct: a status determination 1988].

This article reviews the pertinent literature from the last decade. The following conclusions are drawn: 1) Intravenous thrombolysis given within 6 h after onset of myocardial infarction symptoms significantly improves short- and long-term survival. To evaluate the relative efficacy and safety of various thrombolytic agents, randomized trials directly comparing these agents are needed. 2) Efficacy of thrombolysis must be demonstrated not just by restoring coronary patency, but in consistent limitation of infarct size and more so in reduced short- and long-term mortality. 3) Long-term improvement of left ventricular function due to adequate reperfusion of an infarct-related artery most probably is the essential mechanism for reduced mortality. For direct salvage of ischemic myocardium, however, initiation of treatment within 4 h of symptom onset is mandatory. 4) Immediate coronary angiography and angioplasty is not superior to non-invasive treatment but carries a significant complication and mortality risk. Thus, immediate invasive strategy should be avoided. 5) The major untoward side effects related to thrombolysis are hemorrhagic events predominantly at catheterization or other puncture sites; this stresses the need for minimizing invasive procedures. A more frequent occurrence of intracranial hemorrhage is balanced by less ischemic strokes, especially with additional administration of acetylsalicyclic acid. 6) Thrombolytic therapy carries the risk of continuing ischemia post infarction. Patients with persistent or recurrent clinical symptoms or a major ischemic response detected by non-invasive risk stratification need coronary angiography and revascularization therapy. The role of revascularization therapy in patients with minor or no ischemic response to early submaximal exercise testing requires further studies.