Thrombolytic Therapy for Acute Myocardial Infarction

¹ The Division of Cardiology, Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor.

Early thrombolytic therapy and aggressive coronary revascularization have dramatically changed the prognosis in patients with AMI. Coronary care units and the electrical defibrillator reduced in-hospital mortality rates from 30% to 15% 20 years ago, but no further improvement was realized until thrombolytic therapy was advanced. Now the in-hospital mortality rates following thrombolytic therapy are 4-8%. Moreover, mortality in the year following hospital discharge has been reduced from approximately 10% to 2% by maintaining infarct artery patency and relieving postinfarction ischemia in many patients by angioplasty or bypass graft surgery. Very successful public education programs have been waged against cigarette smoking, hypertension, and hypercholesterolemia. It is now time to educate the public about the symptoms of AMI and to encourage early evaluation, so that the benefits of electrical defibrillation, thrombolytic therapy, and coronary revascularization can be made available to as many patients as possible.