Intracoronary thrombolysis with streptokinase in acute myocardial infarction is an aggressive and efficacious endeavor in appropriately selected candidates. 1'~ Although more data from controlled studies are necessary, the procedure is rapidly gaining acceptance. Hospitals across the country are initiating programs utilizing streptokinase thrombolysis. The euphoria of success should not stimulate reckless attempts with this technique. 3 Rapid, appropriate patient selection is essential.
Time is a critical element, for ischemic cellular injury progresses rapidly. Arrhythmias and other complications increase as the ischemic process is allowed to progress. The best candidates have had pain for less than four hours when thrombolysis is attempted. 1'2'4 Therefore, the initial physician-patient contact must set in motion a preconceived plan of diagnosis, selection, preparation, and finally, performance of intracoronary thrombolysis. The emergency physician must be acutely aware of this procedure. Regional availability of trained personnel and facilities with the capacity to deliver this service may eventually change the EMS protocol for transportation of a select group of patients with an acute myocardial infarction. Intrainstitutional protocols and referral patterns must be well organized to enhance success.
The emergency physician plays a critical role in this new area of cardiology. Tragically, the coronary vessel is often occluded with red tape as well as clot. This bureaucratic impedance must be eliminated if appropriate patients are to be moved from the emergency department to the catheterization lab expediently. Personnel and equipment must be