New Thrombolytic Agents: Does Direct Angioplasty Still Have a Role?

The optimal method of reperfusion for patients with ST-segment elevation acute myocardial infarction has been a point of controversy over the last two decades. Tenecteplase and reteplase are comparable to accelerated-dose alteplase but more convenient because they can be delivered as a bolus. Combination regimens represent a further advance in reperfusion therapy; planned and ongoing studies will evaluate the clinical efficacy and safety of combination therapy. Promising early results of primary coronary intervention with glycoprotein IIb/IIIa receptor inhibition have been reported, and this strategy may emerge as a mainstay of therapy at hospitals with on-site interventional facilities. A possible future approach that could be universally applied consists of combination therapy and adjunctive/rescue percutaneous intervention in selected patients.