Although acute ST elevation myocardial infarction (STEMI) was described nearly a century ago, it remains a major health problem not only in the U.S. but also worldwide with more than three million people suffering STEMI every year. Primary percutaneous coronary intervention (PPCI) is now the treatment of choice for the management of patients with STEMI. In the 20th century, fibrinolytics were the agents of choice for the management of patients with acute STEMI and they continue to be utilized in centers where PPCI facilities are not readily available. Large-scale trials were performed comparing streptokinase and new agents such as the recombinant tissue-type plasminogen activators. This article discusses the use of recombinant tissue plasminogen activators for the management of patients with acute STEMI and the importance of restoring optimal timely reperfusion of the myocardium.
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