[Thrombolytic therapy in acute myocardial infarct].

Numerous studies have demonstrated a high prevalence of coronary thrombi in the early hours of acute myocardial infarction leading to a complete occlusion of the coronary artery. Thrombolysis and reperfusion in the very early hours can preserve jeopardized myocardium from necrosis. Using intravenous streptokinase early reperfusion can be achieved in 50% of the patients with occluded coronary arteries. Using rt-PA and prourokinase reperfusion rate is 60 to 70%. Both agents have more fibrin-specific activity, therefore the risk of bleedings is reduced. However, thrombolytic treatment with early reperfusion seems to be just the first step. Further procedures (percutaneous transluminal coronary angioplasty = PTCA or early bypass surgery) have to be added to improve not only the short-term but also the long-term prognosis. If the ongoing randomized trials confirm a significant reduction in mortality due to reperfusion and improved ventricular function this "aggressive treatment" of the evolving myocardial infarction will change our strategy from a symptomatical to a more causal therapy.