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Calcium-channel blockers as adjuvant therapy postthrombolysis
1Cardiology Section, Department of Veterans Affairs Medical Center, Boston, Massachusetts 02130.
Insights
Successful thrombolytic therapy for acute myocardial infarction can lead to an incomplete infarction. This review explores similarities with non-Q-wave infarction and discusses calcium-channel blockers as adjunctive therapy.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Successful thrombolytic therapy for acute myocardial infarction (AMI) alters transmural necrosis, leading to an incomplete infarction.
- This salvaged myocardium is often associated with a patent but stenotic infarct-related artery, resembling non-Q-wave infarction.
Purpose of the Study:
- To review features shared between naturally occurring non-Q-wave infarction and successfully reperfused AMI.
- To address the role of adjunctive pharmacologic therapy, specifically calcium-channel blockers, in managing incomplete infarction post-thrombolysis.
Main Methods:
- Review of existing literature comparing non-Q-wave infarction and reperfused AMI.
- Analysis of data from the Diltiazem Reinfarction Study and the Multicenter Diltiazem Post-Infarction Trial (non-Q-wave subset).
Main Results:
- Successfully reperfused AMI shares characteristics with non-Q-wave infarction.
- Calcium-channel blocker therapy, exemplified by diltiazem studies, is considered appropriate adjunctive therapy for post-thrombolysis patients.
Conclusions:
- Incomplete infarction following thrombolysis shares features with non-Q-wave infarction.
- Calcium-channel blockers may serve as effective adjunctive pharmacologic therapy in the management of post-thrombolysis myocardial infarction.
Abstract:
Following successful thrombolytic therapy for evolving acute myocardial infarction, the inevitable process of transmural necrosis is favorably altered in a majority of patients, resulting in an aborted, or interrupted, myocardial infarction. Presumably, such myocardial salvage results in an "incomplete" infarction, which is often associated with a patent (but residually stenotic) infarct-related coronary artery. In this regard, the acute myocardial infarction successfully reperfused with thrombolytic therapy resembles non-Q-wave infarction. The subsequent pharmacologic therapy of the "incomplete" infarction remains ill-defined. This article reviews the features which "naturally occurring" non-Q-wave infarction shares with the successfully reperfused myocardial infarction. In addition, the role of adjunctive pharmacologic therapy with calcium-channel-blocker therapy is addressed; in particular, the results of the Diltiazem Reinfarction Study and the non-Q-wave infraction subset analysis of the Multicenter Diltiazem Post-Infarction Trial are discussed to provide the conceptual basis for considering such treatment appropriate adjunctive pharmacologic therapy for the postthrombolysis patient.