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Updated: Jul 14, 2026
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Does coronary angioplasty after timely thrombolysis improve microvascular perfusion and left ventricular function
Luciano Agati1, Stefania Funaro, Mariapina Madonna
1Department of Cardiology, La Sapienza University, Rome, Italy. luciano.agati@uniroma1.it
Insights
Early percutaneous coronary intervention (PCI) after thrombolysis for ST-segment elevation myocardial infarction (STEMI) preserves heart function better than lysis alone. This approach offers a valuable alternative when primary PCI is not immediately available.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Emerging data suggest percutaneous coronary intervention (PCI) is superior to no PCI or ischemia-guided PCI in stable ST-segment elevation myocardial infarction (STEMI) post-thrombolysis.
- The pathophysiologic basis for these findings requires elucidation.
- This study investigates whether complete mechanical recanalization of the infarct-related artery enhances clinical benefits by improving coronary microcirculation.
Purpose of the Study:
- To test the hypothesis that improved microvascular perfusion following complete mechanical reperfusion contributes to better clinical outcomes in STEMI patients.
- To compare the effects of primary PCI, thrombolysis with subsequent PCI, and thrombolysis alone on microvascular function and myocardial salvage.
Main Methods:
- Analysis of 96 STEMI patients randomized within 3 hours of symptom onset.
- Groups included primary PCI (n=36), tenecteplase followed by PCI within 24 hours (n=30), and tenecteplase alone (n=30).
- Microvascular perfusion assessed by myocardial contrast echocardiography; various cardiac function parameters evaluated at multiple time points.
Main Results:
- No significant differences in baseline characteristics between groups.
- Similar microvascular damage and myocardial salvage in primary PCI and post-lysis PCI groups.
- Thrombolysis alone (Group C) resulted in greater microvascular damage, larger infarct size, and depressed left ventricular function compared to PCI-treated groups.
Conclusions:
- Early PCI following thrombolysis is more effective in preserving myocardial perfusion and function than thrombolysis alone.
- This strategy represents a beneficial alternative when primary PCI is not accessible for STEMI patients.
Background:
Recent data show that percutaneous coronary intervention (PCI) in patients with stable postthrombolytic ST-segment elevation myocardial infarction (STEMI) is better than no PCI or ischemia-guided PCI. These results still have to find a pathophysiologic explanation. We hypothesized that complete mechanical recanalization of infarct-related artery improves clinical benefits of thrombolysis as a result of more preserved and better perfused coronary microcirculation. To test this hypothesis, we studied a selected STEMI population presenting very early after symptom onset in whom successful infarct-related artery reperfusion was obtained by thrombolysis followed or not by elective PCI within 24 hours, and we compared these 2 groups with those underwent primary PCI.
Methods:
This study analyzed 96 patients with STEMI randomized within 3 hours from symptom onset to primary PCI (group A, n = 36), tenecteplase followed within 24 hours by PCI (group B, n = 30), or to tenecteplase alone (group C, n = 30). Microvascular perfusion was assessed by myocardial contrast echocardiography. Regional contrast score, endocardial length and area of contrast defect on day 2 (T1) and at predischarge (T2), left ventricular end-diastolic volume, regional wall motion score, extent of wall motion abnormalities, and ejection fraction at T1, T2, and at 3 months' follow-up were calculated.
Results:
Baseline clinical and angiographic characteristics were not statistically different between groups. The extent of microvascular damage and of myocardial salvage was similar in primary PCI-treated or in invasively treated patients after lytic administration. Conversely, group C patients, although treated very early with fibrinolytic therapy, showed higher extent of microvascular damage and infarct size and a more depressed left ventricular function after reperfusion and at follow-up.
Conclusions:
Our data suggest that early PCI after lysis is more effective in preserving myocardial perfusion and function than lysis alone and may be a helpful alternative when primary PCI is not available.
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