Facts and Hopes in Thrombolysis in Acute Myocardial Infarction

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It was a great pleasure for us to welcome so many experts from all over the world to our symposium in Aachen. We are also pleased - and you can attribute this to my own vanity - with the success and acceptance of the concept of myocardial reperfusion and revascularization - specifically selective intracoronary lysis followed either by PTCA or bypass surgery - which we have been pursuing since 1979. But after the dramatic immediate effects of the first attempts, which you have to experience yourself, we did not expect it to be any different. We decided against performing a randomized study in which every patient is catheterized, and thrombolytic therapy only given to some of the patients, for which we have been criticized at times. At the previous symposium in Aachen in 1983 on the topic of thrombolysis for acute myocardial infarction, in the final session several speakers were asked directly about this topic, and replied that if they were patients they would not want to be randomized into the placebo group. In the meantime positive results from large, randomized studies have been recorded, which are presented in this volume. I mention in particular the Western Washington Study from Dr. Kennedy and the Interuniversity Study in Holland. Aachen, a relatively small city with 250,000 inhabitants, provided the opportunity to treat a relatively large patient population with acute myocardial infarction.