Mortalit in the Thrombolytic Era

An ever-growing proportion of patients with acute myocardial infarction undergo coronary thrombolysis; recent estimates indicate that in the United States, about 20% of the annual 700,000 patients with myocardial infarctions receive such therapy.' Even though thrombolysis reduces short-term mortality by approximately 20-30%,2-5 each year a large number of patients leave the hospital with a substantial residual risk of dying. Factors that determine prognosis after myocardial infarction and algorithms for risk stratification have been well established for the prethrombolytic era.6-10 However, it remains to be shown whether these predictors of outcome and risk stratification strategies also apply to the growing proportion of patients who have undergone thrombolysis, and if so, whether high-risk patients selected on the basis of such strategies may benefit from more intense medical or surgical treatment.