Stanislav Šimek, Petr Kuchynka, Lubor Goláň, Vilém Danzig, Vratislav Mrázek, Michael Aschermann, Aleš Linhart
The thrombolytic treatment (TT) represented a revolutionary milestone in the treatment of acute myocardial infarction (AMI) with robust evidence of prognostic benefit. TT is relatively cheap and its application is easy. The effectivity of TT is high in early phases of AMI but it decreases significantly with time delay. The early prehospital application of TT proved superiority over delayed treatment in a hospital. However, due to its limitations the TT is being replaced with even more effective though more expensive and more sophisticated primary coronary angioplasty (PPCI). According to the European Society of Cardiology guidelines the TT is recommended for treatment of AMI if the PPCI is not achievable. Patients admitted to the hospital with catheterization laboratory should always be treated with PPCI. In a patient admitted to the hospital without catheterization laboratory within first three hours after the onset of pain the TT is considered to be a treatment modality on mortality is comparable with transport to PPCI. After 3rd hour of AMI the transport to PPCI compared to TT reduces mortality and therefore is the treatment of choice, if available. Dual antiaggregation therapy with aspirin + clopidogrel should be the part of TT. All patients should undergo coronary angiography after TT.