Coronary thrombolysis with tissue-type plasminogen activator (t-PA)

Abstract

Coronary thrombolysis is presently under intensive investigation as a treatment for acute myocardial infarction for two main reasons. Firstly it is now well established that acute myocardial infarction is often associated with thrombotic occlusion of an atherosclerotic coronary artery [1]. Secondly it has been shown that administration of thrombolytic agents can reopen an occluded coronary artery in the majority of patients [2, 3] and that reperfusion of ischemic myocardial tissue is generally well tolerated. Coronary thrombolysis is however not a goal in itself but is employed to prevent necrosis and dysfunction of jeopardized myocardial cells. There is ample evidence in animals that the infarct size is smaller and the myocardial function better when an occluded coronary artery is reopened within at most a couple of hours [4]. The proof that coronary reperfusion is of real benefit to patients with acute myocardial infarction in terms of morbidity or mortality is however still lacking [5–7]. To this end several large-scale trials are currently in progress.