Thrombolysis is well established as effective therapy in AMI. Two thrombolytic agents, streptokinase and tissue plasminogen activator (tPA), are now widely available for clinical use. These agents have different effects, and there has been considerable debate as to which is superior. Both are effective in preserving myocardial function and reducing mortality. However, the confidence limits of these findings overlap, and no firm conclusions can be made from comparing trials enrolling different populations with different baseline characteristics and ancillary treatments such as angioplasty. There have been few "head-to-head" comparisons. These trials show that tPA achieves better lysis rates than streptokinase, but the theoretic advantage of fibrin specificity does not result in fewer adverse effects or greater preservation of LV function. Although each drug may have specific indications, the drugs appear similar in clinical benefit, and further comparison trials are required.