Immediate and late results of thrombolysis on infarct size, left ventricular function and survival after successful reperfusion

The aim of coronary reperfusion by thrombolysis in acute myocardial infarction (AMI) is the improvement of left ventricular function and of survival as a result of the reduction of infarct size. Although most of data presented in the literature are from non-randomized trials the following conclusions seem to be justified: 1. The immediate results in terms of reopening rate, decrease of infarct size, improvement of regional wall motion in the infarct area and early (hospital) mortality depend on a.) the time delay between AMI and the application of the thrombolytic agent, which is linked to b.) the reperfusion rate (successful reopening), c.) the size of the occluded vessel, which determines in combination with the degree of collateralization the initial infarct size and - at least partially - the initial hemodynamic state, d.) the age. 2. Among these, the time up to reperfusion is the single factor to be influenced by therapy. In 80% of the patients, successfully treated within 2.0 hours, the initial infarct size was reduced and regional wall motion improved. 3. After achieving a favourable immediate result for the longterm course it is of major importance to maintain a sufficient antegrade coronary flow by avoiding reocclusion. Whether aortocoronary bypass-surgery, percutaneous coronary angioplasty, alterations in the dosage and/or duration of the thrombolytic compound or some type of effective anticoagulation or a combination of these measures will be the follow-up therapy of choice has to be clarified by further investigations.