Coronary Thrombolysis

Abstract

The clinical description of acute myocardial infarction (AMI) by Herrick 1 Herrick JB. Clinical features of sudden obstruction of the coronary arteries. JAMA. 1912; 59: 2015-2020 Crossref Google Scholar in 1912 embodied the concept that acute coronary thrombosis was responsible, and this view was widely adopted. The first trial of IV administration of thrombolytic therapy was published in 1959 2 Fletcher AP Sherry S Alkjaersig N et al. The maintenance of a sustained thrombolytic state in man: II. Clinical observations on patients with myocardial infarction and other thromboembolic disorders. J Clin Invest. 1959; 38: 11-19 Google Scholar and the first of intracoronary use was published in I960. 3 Boucek HJ Murphy WP. Segmental perfusion of the coronary arteries with fibrinolysin in man following a myocardial infarction. Am J Cardiol. 1960; 5: 525-533 Abstract Full Text PDF Google Scholar Over the next 25 years, 24 randomized studies of IV thrombolytic therapy were conducted, primarily in Europe, 4 Yusuf S Collins R Peto R et al. Intravenous and intracoronary fibrinolytic therapy in acute myocardial infarction: overview of results on mortality, reinfarction and side effects from 33 randomized controlled trials. Eur Heart J. 1985; 6: 556-585 PubMed Google Scholar the results varying from statistically significant benefit to no suggestion of benefit, and thrombolytic therapy was rarely used. In the late 1970s, there was a reawakening of interest in thrombolytic therapy for AMI, initially directed at intracoronary administration. 5 Chazov EL Mateeva LS Mazaer AV et al. Intracoronary administration of fibrinolysis in acute myocardial infarction. Ter Arkh. 1976; 48: 8-19 PubMed Google Scholar ,6 Rentrop KP Blanke H Karsch KR et al. Selective intracoronary thrombolysis in acute myocardial infarction and unstable angina pectoris. Circulation. 1981; 63: 307 Crossref PubMed Google Scholar The reality that most hospitals do not have cardiac catheterization laboratories and the recognition of the economic and logistic impediments to emergency cardiac catheterization, even in referral hospitals, stimulated a reevaluation of IV thrombolytic therapy. 7 Schroeder R Biamino G Leitner E-R et al. Intravenous short-term infusion of streptokinase in acute myocardial infarction. Circulation. 1983; 67: 536-548 Crossref PubMed Google Scholar ,8 Lo YSA. Intravenous versus intracoronary streptokinase in acute myocardial infarction. Clin Cardiol. 1985; 8: 609-619 Crossref PubMed Google Scholar