CORONARY DISEASE: Acute myocardial infarction: failed thrombolysis

Abstract

Reperfusion strategies in the early phase of treatment of acute myocardial infarction aim to rapidly normalise and maintain tissue perfusion. Primary angioplasty is probably the best current treatment but it can only be applied to a minority of patients and has its own problems. Thrombolysis remains the most commonly used treatment. It has well demonstrated benefits, saving lives and reducing left ventricular damage, but is far from perfect.1 The mega-trials have sent a clear message that the greatest benefits are seen with patients who are treated early. Clinical efforts have therefore been concentrated on educating the population to heed the early symptoms, encouraging rapid admission to hospital (sometimes with thrombolytic treatment being administered in the ambulance) and minimising “door to needle” times. Continuous and widespread use of audit increases the number of patients treated and the speed with which treatment is administered.#### Key points