It is now clear that intravenous thrombolytic therapy is the treatment of choice in selected patients with AMI. It is most effective in patients with their first MIs and of greatest benefit, at least in the short term, for those with large infarctions. It should be given within the first three hours to be most effective and there probably is little benefit for patients after 5-6 hours unless there is evidence of ongoing ischemia. Patients must be selected carefully to reduce the likelihood of serious complications, including intracerebral hemorrhage. There is, as yet, no convincing evidence that early intervention with PTCA or surgery can improve the outcome of patients who have received initial early intravenous thrombolytic therapy when they develop recurrent myocardial ischemia (21,22). The use of rt-PA probably is preferable to the use of streptokinase, but further experience is needed before this can be determined with certainty. The large difference in the cost of these agents will need to be evaluated by the medical community and other health care providers who finally will determine the pattern of use of these and future thrombolytic agents.
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