Clinical trials in acute myocardial infarction

Long-term follow-up of placebo-controlled thrombolysis trials has proven th at the survival benefit from thrombolysis in acute myocardial infarction (A MI) is maintained for up to 10 years. Ongoing research is being conducted w ith the aim to further improve early restoration of blood flow in the infar ct vessel and, thus, reperfusion of the infarcted myocardium in patients wi th AMI, with the ultimate goal to improve survival. In two recent mega-tria ls, two new single-bolus fibrinolytics (lanoteplase and TNK-tissue plasmino gen activator) were shown to be equivalent to front-loaded alteplase in red ucing infarct mortality. The ease of application of these agents might help reduce the time from symptom onset to start of therapy. More potent thromb in inhibitors such as hirudin and hirulog seem to speed up thrombolysis wit h streptokinase and reduce the rate of reinfarctions. Very promising result s are derived from angiographic trials combining reduced doses of thromboly tics with glycoprotein IIb/IIIa inhibitors. Advances in mechanical revascul arization can be achieved with the use of stents and better conjunctive the rapies. All of these developments are expected to further improve clinical outcome of patients with AMI in the near future. Curr Opin Cardiol 1999, 14 :392-402 (C) 1999 Lippincott Williams & Wilkins, Inc.