Search for more effective and safe drugs has recently led to the design of second-generation thrombolytic enzymes one of which is recombinant tissue plasminogen activator. A total of 80 patients including 41 who received tissue plasminogen activator (TPA) (Group 1), 39 on streptokinase (SK) (Group 2) were examined. By the 90th minute of thrombolytic infusion, coronary blood flow was recovered in 27 (66%) patients from Group 1 and 19 (49%) from Group 2 (p = 0.12). A decrease in fibrinogen concentration by less than 1 g/l was seen in 7 (18.4%) patients from Group 1 and in 29 (82.9%) patients from Group 2 (p = 0.00005). The levels of fibrinogen and plasminogen during 36 hours of initiation of thrombolytic infusion were statistically significantly lower in Group 2. The incidence of hemorrhages was the same in the two groups and equal to 26.8 and 28.0% in Groups 1 and 2, respectively. All the patients had no hemorrhages requiring transfusion of blood and its substitutes, as well as no cerebral circulatory disorders in the first week of the disease.

In early (mean time, 6.9 +/- 0.2 hours following the onset of an anginal episode), 99mTc pyrophosphate myocardial scintigraphy was performed in 28 patients who received thrombolytic therapy under angiographic monitoring. The sensitivity and specificity of an early administration of pyrophosphate into the myocardium as a noninvasive marker of successful coronary reperfusion was 95.7% and 100%, respectively.