Editorial: optimal thrombolysis

Thrombolytic therapy is an established reperfusion strategy in acute myocar dial infarction with proven long-term survival benefit. New thrombolytic ag ents including reteplase, lanoteplase, and tenecteplase have been developed to optimize thrombolytic therapy. With respect to efficacy the new thrombo lytic agents show mortality equivalent to front-loaded alteplase, the prese nt gold standard of thrombolytic therapy. With respect to ease of applicati on there are advantages because third generation agents can be given as a s ingle or double bolus instead of a bolus followed by an infusion. The most promising strategy to optimize coronary thrombolysis seems to be the combin ation of thrombolytic agents in reduced dose and GP IIb/IIIa blockers in fu ll dose. The corresponding clinical trials (TIMI-14, SPEED, and INTRO-AMI) have also shown that there is an evolution in the surrogate end points for an optimal thrombolysis. In the past, optimal thrombolysis was associated w ith an open infarct-related coronary artery. A few years ago it was realize d that TIMI-3 flow in the epicardial coronary artery was associated with th e best results. Presently, normal myocardial micro circulation is regarded an additional prerequisite for further reduced mortality in acute myocardia l infarction.