Bedside cardiology and thrombolysis

The study by Christian et al. (37) provides useful clinical information for the management of the patient with myocardial infarction with thrombolytic therapy. 1) Complete resolution of chest pain during the infusion of an intravenous thrombolytic agent suggests reperfusion and myocardial salvage. Initial conservative medical management should be considered in these patients especially if serial ECGs show a progressive and rapid downward defection of the ST segment. 2) Patients presenting within 6 h after the onset of infarction, who are pain free, may still benefit from thrombolysis if their ECGs show persistent ischemia. 3) In the remaining patients in whom chest pain does not resolve completely during thrombolytic therapy, management, whether continued medical or invasive strategy, should be individualized and dictated by the extent of myocardium at risk (i.e., by the number of ECG leads showing ST segment elevation), the response of the ST segment to thrombolysis and, most important, the clinical status of the patient.