Objectives
To examine the clinical and cost-effectiveness of available drugs for early thrombolysis in the treatment of acute myocardial infarction (AMI) in hospital and pre-hospital settings.

Background
Coronary heart disease (CHD) is a major cause of morbidity and mortality in the UK accounting for around 125,000 deaths a year. AMI affects an estimated 274,000 people each year. Of these, approximately 50% (137,000) die within 30 days of AMI and over half these deaths occur prior to reaching hospital or other medical assistance.

The development and introduction of new pharmacological agents has made it necessary to review the clinical and cost effectiveness of older and newer agents used for early thrombolysis. Those reviewed in this document include: streptokinase, alteplase, reteplase and tenecteplase.