Value and limitations of thrombolytic therapy in early acute transmural myocardial infarction.

Since coronary thrombosis is the final common pathway by which acute transmural myocardial infarction occurs, intracoronary thrombolytic reperfusion has taken on new significance. The goals of early restoration of coronary blood flow are to reduce mortality as well as to demonstrate improvement of markers of success or failure associated with thrombolytic therapy relative to nonreperfused patients. This paper examines clinical studies from multiple centers and the results derived from these studies. Mortality, left ventricular function, electrocardiographic indices of necrosis, laboratory studies, enzymatic indices of myocardial infarction size, thallium perfusion, and scintigraphic studies from controlled randomized and nonrandomized studies are presented. Overall, it appears that thrombolytic reperfusion is beneficial if applied early, although the markers of success or failure do not necessarily correlate with short-term mortality.