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Updated: Sep 12, 2026
Myocardial Infarction and Functional Outcome Assessment in Pigs
Published on: April 25, 2014
Effects of late administration of tissue-type plasminogen activator on left ventricular remodeling and function after
D Bonaduce1, M Petretta, B Villari
1Institute of Internal Medicine, Cardiology and Heart Surgery, Second School of Medicine, Naples, Italy.
Insights
Late thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) improved left ventricular volume and function in acute myocardial infarction patients. This intervention reduced myocardial expansion, positively influencing postinfarction left ventricular remodeling.
Area of Science:
- Cardiology
- Interventional Cardiology
- Myocardial Infarction Research
Background:
- Acute myocardial infarction (AMI) can lead to significant left ventricular (LV) remodeling and dysfunction.
- Timely reperfusion therapy is crucial in managing AMI, but the benefits of late thrombolysis are still being investigated.
Purpose of the Study:
- To evaluate the impact of late thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) on left ventricular volume and function in patients with acute anterior myocardial infarction.
Main Methods:
- 34 patients with AMI were divided into three groups: early rt-PA (Group A), late rt-PA (Group B), and conventional therapy (Group C).
- Two-dimensional echocardiography and radionuclide angiography were used to assess LV volumes and ejection fraction at predischarge and 1-year follow-up.
- Coronary angiography assessed infarct-related vessel patency and Thrombolysis in Myocardial Infarction (TIMI) coronary perfusion grade.
Main Results:
- Late rt-PA treatment (Group B) and early rt-PA (Group A) showed improved infarct-related vessel patency and TIMI perfusion grades compared to conventional therapy (Group C).
- Patients receiving rt-PA (Groups A and B) exhibited smaller LV end-systolic and end-diastolic volumes and higher ejection fractions at predischarge and 1-year follow-up compared to Group C.
- LV remodeling was more favorable in rt-PA treated groups, with significant improvements in LV volumes observed over the 1-year follow-up.
Conclusions:
- Late thrombolysis with rt-PA demonstrates beneficial effects on left ventricular remodeling and function in acute myocardial infarction.
- The positive impact of late thrombolysis may be attributed to reduced myocardial expansion, leading to improved postinfarction LV geometry.
- These findings support the consideration of rt-PA administration beyond the traditional early time window in selected AMI patients.
Abstract:
To evaluate the effects of late thrombolysis on left ventricular volume and function in acute myocardial infarction, two-dimensional echocardiography and radionuclide angiography were performed before discharge and after 1 year of follow-up study in 34 patients with acute anterior myocardial infarction. Of these, 10 admitted to the coronary care unit within 4 h from the onset of symptoms were treated with recombinant tissue-type plasminogen activator (rt-PA) (Group A) and 24 admitted between 4 and 8 h after onset were randomly assigned to receive either rt-PA (Group B, n = 12) or conventional therapy (Group C, n = 12). Seven to 10 days after admission, all patients underwent cardiac catheterization and coronary angiography. Patency of the infarct-related vessel was 70% in Group A, 66% in Group B and 33% in Group C and the average Thrombolysis in Myocardial Infarction (TIMI) coronary perfusion grade was 1.9 +/- 0.8 for Group A, 1.6 +/- 1.0 for Group B and 0.84 +/- 0.95 for Group C (Group A versus Group C p less than 0.01; Group B versus Group C p less than 0.05). At predischarge evaluation, mean left ventricular end-systolic and end-diastolic volumes were higher in Group C than in Group B (p less than 0.001 and 0.05, respectively) and Group A (p less than 0.005 for both); mean left ventricular ejection fraction at rest was lower in Group C than in Group B and Group A (p less than 0.05 for both). At 1 year follow-up study, end-systolic and end-diastolic volumes remained higher in Group C than in Group B (p less than 0.05 for both) and Group A (p less than 0.005 for end-systolic volume and p less than 0.001 for end-diastolic volume); ejection fraction at rest was lower in Group C than in Groups A and B (p less than 0.05 for both); during exercise, it increased more in Group A than in Group C (p less than 0.01). Comparison of data obtained before discharge and at the 1 year follow-up study revealed a significant differences in end-systolic volume (p less than 0.05) in Group C patients and in end-diastolic volume in patients in Groups B (p less than 0.05) and C (p less than 0.001). The beneficial effect of late thrombolysis with rt-PA may be related to a reduction in myocardial expansion and thus to a favorable influence on postinfarction left ventricular remodeling.
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