Optimizing thrombolytic therapy of acute myocardial infarction.

M ajor advances in medicine rarely burst upon the scene fully developed and immediately applicable to a large majority of the potential beneficiaries. More commonly, after the initial studies in which the clinical value of a new discovery is demonstrated, there is a period during which the precise indications are established and "tooling up" occurs. For example, following the development of the coronary care unit, coronary artery bypass grafting, and percutaneous transluminal coronary angioplasty, it took several years to work out the precise clinical indications for the use of each of these modalities, for the training of personnel, and for the manufacture of the equipment necessary for widespread application. Thrombolytic therapy of acute myocardial infarction has now reached the stage at which the clinical value of the technique for many patients has been clearly established and is no longer in dispute,12 and it is now undergoing clinical application. However, making this form of treatment available to all or nearly all patients with myocardial infarction who can benefit from it is now an important challenge.