Thrombolytic Therapy in Acute Myocardial Infarction Part II: 1997 Update

Thrombolytic therapy has become an established treatment for acute myocardial infarction. Streptokinase was first demonstrated in 1988 to reduce mortality rates. In 1993, tissue plasminogen activator was shown to have a slight superiority over streptokinase in reducing mortality rates (approximately 1%). Reteplase is a second generation thrombolytic agent that is given in two bolus injections intravenously over 30 minutes. Studies demonstrated slightly better and more rapid improvement in myocardial perfusion with reteplase compared to tissue plasminogen activator. However, recent studies showed 30-day mortality rates in patients treated with reteplase were similar as those treated with tissue plasminogen activator. The use of angioplasty, aspirin, beta blockers, angiotensin converting enzyme inhibitors, and lipid lowering agents also contribute to the reduction of mortality from acute myocardial infarction.