New Accelerated rt-PA Strategy Has Sufficient Advantage over Older Streptokinase Strategies that It should Be the Trhombolytic Strategy of Choice in Anterior and Large Infarctions.

The major goal of myocardial reperfusion therapy is to restore normal coronary blood flow as quickly as possible and to maintain coronary patency in the highest number of patients with acute myocardial infarction. Recent studies support the hypothesis that more rapid and complete restoration of coronary flow through the infarct-related artery results in improved ventricular performance and lower mortality. Accelerated tissue plasminogen activator therapy appears to produce the most favorable effects compared to other lytic strategies, particularly in patients with anterior and large myocardial infarctions. However, the finding in GUSTO II trial, that even with the best strategy only 54% of patients had TIMI grade 3 flow, suggests that further improvement in the treatment of acute myocardial infarction may be possible in the future. The effectiveness of thrombolytic therapy may be enhanced by earlier identification of evolving myocardial infarction and reduced time delays in the initiation of thrombolytic therapy, bolus thrombolytic therapy, new thrombolytic agents, or more potent adjunctive antithrombotic strategies.