Thrombolysis in the treatment of acute transmural myocardial infarction.

Since 1980, many data have been published concerning the pathophysiology of acute myocardial infarction and its effect on mortality. Research has been directed at developing a means of interrupting the evolution of transmural infarction and normalizing blood flow through the infarct-related vessel. Intracoronary delivery of thrombolytic agents has proved to be an effective, albeit logistically limited, means of reperfusion. The use of intravenous agents has broadened the applicability of thrombolytic therapy without severely compromising its efficacy. The recent availability of clot-selective agents has produced the potential of safely interrupting the infarction process at the earliest possible moment. This article reviews the research that has led to our use of thrombolytic agents and proposes a reasonable program of patient management in acute myocardial infarction.