Advances in thrombolytic therapy for acute myocardial infarction.

There has been rapid proliferation of understanding and experience with thrombolytic therapy for acute myocardial infarction. Over the last few years, selective intracoronary infusion of lytic therapy has been replaced by intravenous administration because of the fundamental importance of time to reperfusion. Newer thrombolytic agents, such as tissue plasminogen activator (t-PA) and acylated streptokinase (APSAC), with properties distinct from streptokinase (SK) and urokinase, have been developed and have undergone extensive clinical trial evaluation. This review will focus primarily on the recent advances in thrombolytic therapy, with particular attention to efficacy, safety, and comparative aspects of the various agents currently or soon to be available.