PMID: 2193050Jul 1, 1990Paper

Optimal utilization of thrombolytic therapy for acute myocardial infarction: concepts and controversies

Journal of the American College of Cardiology
C L Grines, A N DeMaria


Timely administration of thrombolytic therapy decreases myocardial infarct size, lessens the incidence of congestive heart failure and improves survival. However, available data suggest that only 10% of patients with acute infarction in the United States receive thrombolytic drugs. Given the benefits of thrombolytic therapy, all patients with myocardial infarction would likely be treated were it not for associated risks. Several groups exist in which the risk/benefit ratio of thrombolytic therapy continues to be controversial, including those with inferior infarction, absence of ST segment elevation or presentation greater than 6 h from symptom onset, elderly patients and those with hypertension. Three recent thrombolytic trials reported a reduction in mortality that was entirely independent of infarct location. Pooled data from trials involving 12,000 patients with inferior infarction have demonstrated a reduction in mortality rate (6.8% versus 8.7%, p less than 0.0001). Furthermore, improvement in regional and global left ventricular function occurred after reperfusion therapy of inferior infarction. Pooled data indicate that patients treated between 6 and 24 h after symptom onset have a lower mortality rate than do those who...Continue Reading


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