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Braunwald et al.'s hypothesis that the extent of myocardial injury reflects the degree of imbalance between myocardial oxygen supply and oxygen requirements gained wide acceptance in the 1970s as a result of observations in both experimental animals and patients [1]. It soon became clear that reduction of myocardial oxygen requirements by itself only modestly attenuated the extent of ischemic injury [2]. Subsequently, major efforts have been made to develop techniques that directly restore nutritive myocardial perfusion. In particular, with the knowledge that thrombotic coronary occlusion occurs in the vast majority of patients in the early phase of acute myocardial infarction [3], a rationale for thrombolytic therapy existed. Administration of drugs capable of lysing the intracoronary thrombus seems particularly attractive because its simplicity makes it applicable to most of the patients with acute myocardial infarction. This review summarizes advances related to thrombolytis and suggests additions to or alterations in thrombolytic therapy that could make it even more effective as a therapeutic intervention in the future. [ABSTRACT FROM AUTHOR]