Thrombolysis With Tissue-Type Plasminogen Activator in Acute Myocardial Infarction

RAPID dissemination of preliminary results of research may predispose the medical profession and the public to premature, ill-advised, or indiscriminate acceptance of allegedly therapeutic modalities before efficacy has been established. Objective evaluation of an intervention such as coronary thrombolysis may be obscured by excessive enthusiasm of advocates, undue cynicism of critics, media hype, and real or imagined competitive pressures impinging on the modern practitioner of medicine. In this article we shall consider, in this context, findings pertinent to coronary thrombolysis with conventional activators or tissue-type plasminogen activator (t-PA) in the treatment of acute myocardial infarction. The concept that acute coronary thrombosis is responsible for myocardial infarction is not new. Initial attempts in 1959 by Sherry and associates were made to activate the fibrinolytic system in pilot studies of patients with acute infarction. Subsequently, 13 large-scale trials with intravenous streptokinase were performed in Europe and Scandinavia. Conflicting results ensued, in part