[The variable effect of coronary reperfusion on survival and left-ventricular function: how do thrombolytics act?].

The favourable effects of thrombolytic therapy on survival after acute myocardial infarction can not be attributed solely to a partial recovery of systolic left ventricular function. This is mainly due to the fact that with the current therapeutic regimens early, optimal tissue reperfusion is obtained in only a small percentage of patients with an acute myocardial infarction. However, recanalization of an occluded coronary vessel in itself has beneficial effects by mechanisms other than salvage of ischemic myocardium and preservation of left ventricular function. In view of the striking relationship between reperfusion (early or late) and survival as recently demonstrated by the GUSTO study, new therapeutic developments must be aimed at increasing the percentage of early, optimal and persistent reperfusion.