Review of clinical studies of thrombolytic agents in acute myocardial infarction

Abstract

Much of the current work in the field of thrombolytic therapy in acute myocardial infarction involves short-term, high-dose infusions of lytic agents. From 1983 to 1986, there were five major trials of these agents in acute myocardial infarction: the Western Washington Intracoronary Streptokinase Trial, the Dutch Interuniversity Group Trial, the Italian Group for the Study of Streptokinase in Myocardial Infarction Trial, the Thrombolysis in Myocardial Infarction Trial, and the Intravenous Streptokinase in Acute Myocardial Infarction Trial. This review considers each of these randomized, prospective trials in terms of design, mean time to therapy, lysis rate, reocclusion and in-hospital reinfarction, bleeding complications, in-hospital mortality, late survival, left ventricular function, and post-infarction morbidity. Findings from these trials indicate that thrombolytic therapy, if given less than four to six hours after onset of symptoms, improves the mortality rate and reduces post-infarction morbidity. Bleeding, a major cause of morbidity, can be managed by careful patient selection and clinical observation.