Myocardial infarction in the 1990s. The importance of early thrombolytic therapy.

Substantial advances in the diagnosis and treatment of ischemic heart disease, especially myocardial infarction, have reduced mortality rates during the past several years. This progress is tempered, however, by the continuing large overall incidence of myocardial infarction and cardiac death in persons in their prime years. Preventive measures are important and are usually best applied by primary care physicians. The acute crisis of coronary artery thrombosis demands accurate diagnosis and timely thrombolytic therapy, which has halved the mortality rate of myocardial infarction. Several effective thrombolytic agents are available; on the basis of several large international trials of these drugs, it appears that the benefits of early and appropriate use of any one of these agents outweigh any individual advantages. In addition to thrombolytics, aspirin and heparin are necessary adjunctive drugs for acute myocardial infarction. Nitroglycerin is helpful, but its essential role seems less evident. Earlier use of beta blockers and angiotensin-converting enzyme inhibitors has been proved effective in reducing mortality. Percutaneous transluminal coronary angioplasty is definitely as effective as thrombolytic therapy, but immediate application is logistically challenging in most US hospitals.