Acute myocardial infarction: the case for pre-hospital thrombolysis with or without percutaneous coronary intervention.

T he open artery hypothesis suggests that establishing reperfusion as soon as possible after the onset of symptoms of acute myocardial infarction should be a priority; this has been highlighted as an important objective in the National Service Framework document in the UK. Currently, patients with acute myocardial infarction are treated with thrombolytic therapy or by percutaneous coronary intervention (PCI). The vast majority at the present time receive in-hospital thrombolysis. With thrombolytic treatment, the earlier that patients are treated, the better their outcome. As a result, there has been a move towards the administration of thrombolytic treatment before hospital admission.