Very early thrombolysis in acute myocardial infarction. The Jerusalem experience

Background. Myocardial damage in acute myocardial infarction is a time dependent process. Thrombolytic therapy effectively opens the coronary artery, restores coronary blood flow and prevents ongoing necrosis. Methods. We examined the influence of very early thrombolytic therapy (including prehospital administration) in a consecutive group of 760 patients with myocardial infarction on mortality, complications and the preservation of left ventricular function. Results. Seven hundred and sixty patients received early thrombolytic therapy: 114 at home (time delay to treatment 1.2 ± 0.6 hours) and 646 in hospital (2.0 ± 1.0 hours). Sixteen patients died in hospital and major hemorrhage occurred in 10. The arterial patency rate in 616 patients who underwent coronary angiography 6 days later was 82%. Infarct size measured by left ventriculography war determined by the area at risk, the delay time until the initiation of thrombolytic therapy, the total duration of ischemic pain and the degree of restoration of arterial blood flow. Conclusion. Early thrombolytic therapy, particularly prehospital management, is feasible and safe and reduces infarct size and mortality. A further decrease in a delay to initiation of treatment and more effective thrombolytic therapy will further decrease mortality and myocardial damage.