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Coronary thrombolysis--a perspective for the practicing physician.

Acute myocardial infarction is the most common cause of death in most Western countries. The clinical description of acute myocardial infarction by Herrick1 in 1912 suggested that acute coronary thrombosis was responsible. Indeed, the possibility of lysing occlusive thrombi in the coronary arteries was the principal rationale for the first trial of thrombolytic therapy with streptokinase in 19592. In the 1960s and 1970s, several randomized studies of intravenous thrombolytic therapy were conducted. However, widely varied treatment protocols and end-point analyses, along with small samples, produced conflicting results3. Furthermore, during this time the pathogenetic role of coronary-artery thrombus was . . .