[rt-PA in acute myocardial infarct, randomized studies in Europe and the USA].

Thrombolysis in acute myocardial infarction will only have a future if an intravenous route makes this treatment applicable in all patients and in all hospitals. The data available now indicate that rt-PA is more thrombus-specific than streptokinase (SK) and that its thrombolytic activity is higher. The frequency of severe bleedings is low. Reperfusion can be reached in a significantly higher number of patients in comparison to SK (60% vs. 36%; p less than 0.001) (TIMI trial). In the European trial perfusion was observed in 70% of the patients treated with rt-PA versus 55% in patients treated with SK. Ongoing randomised trials with rt-PA in Europe and in the U.S.A. investigate the efficacy of thrombolysis in regard to left ventricular function and mortality. These trials will also answer some unsolved questions concerning the role of PTCA after thrombolysis. Other thrombolytic agents such as pro-urokinase and acylated-streptokinase-plasminogen complex are being investigated. Whether they have advantages in comparison to rt-PA is still open.