Dr. Denis DeSilvey
Associate Professor of Clinical Internal Medicine,
Department of Internal Medicine,
Division of Cardiovascular Medicine,
University of Virginia,
Charlottesville, VA.

Thrombolytic therapy for the management of acute myocardial infarction is one of the major advances in cardiovascular medicine in the last fifteen years. Beginning in the mid 1980s, an increasing body of literature supported the concept of the early administration of a thrombolytic agent, either streptokinase or tissue plasminogen activator (TPA), to salvage ischemic myocardium. The concept that 'time is muscle' took hold and has dominated our thinking about the management of acute ST segment elevation injury.

The guidelines of the American Heart Association and the American College of Cardiology¹ as well as the review in the Fibrinolytic Therapy Trialists' Collaborative,² show that fibrinolytic therapy reduces mortality for 18-30% of patients with acute myocardial infarction when given within 6 to 12 hours of the onset of pain. These excellent results were supported by subsequent studies such as the Second International Study of Infarct Survival (ISIS-2)³ and the Gruppo Italiano per lo Studio dell Streptochinasi nell'Infaarcto Miocardico (GISSI).⁴