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Intracoronary thrombolysis and early bypass surgery for acute myocardial infarct: five years' experience
Insights
Selective intracoronary thrombolysis with streptokinase effectively treated acute myocardial infarction in 87% of patients. Early bypass surgery following successful reperfusion improved long-term survival and functional outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute transmural myocardial infarction requires timely reperfusion.
- Intracoronary thrombolysis with streptokinase was a therapeutic option.
Purpose of the Study:
- To evaluate the efficacy and outcomes of intracoronary streptokinase thrombolysis for acute myocardial infarction.
- To assess the role of early bypass surgery in successfully reperfused patients.
Main Methods:
- 469 patients with acute myocardial infarction underwent selective intracoronary thrombolysis with streptokinase.
- Coronary arteriography assessed vessel patency before and after treatment.
- Early bypass surgery was performed in selected reperfused patients.
Main Results:
- Streptokinase achieved successful reperfusion in 87% of patients with complete occlusion.
- Early mortality in the surgically treated group was 1.5%, with 92% 5-year survival.
- Left ventricular aneurysm occurred in patients with ischemia > 3 hours.
Conclusions:
- Intracoronary thrombolysis with streptokinase is effective for acute myocardial infarction.
- Combining thrombolysis with early bypass surgery offers optimal therapy and improved long-term survival.
Abstract:
During the five-year period between March 1980 and February 1985 selective intracoronary thrombolysis with streptokinase was performed in 469 patients with clinical and ECG signs of acute transmural myocardial infarct. Coronary arteriography prior to thrombolysis showed the infarct related vessel still or again patent in 21% of the patients. Among 372 patients with complete occlusion streptokinase infusion was successful in 87%, but failed in 13%. Due to the high risk of reocclusion, early bypass surgery was performed in 69 patients (18.5%) of the successfully reperfused group. Indication was based primarily on an ischemic time interval of less than 4 hours between the acute onset of clinical symptoms and reperfusion. Early mortality was 1.5% in this surgically treated group and actuarial survival was 92% at 5 years with all but 3 patients in functional class I or II. Marked but non-fatal early congestive heart failure was more significant when patients underwent operation within the first 2 days after thrombolysis than thereafter. Late recatheterization studies in 29 patients showed a slight but statistically insignificantly higher occlusion rate for vein grafts to the infarct vessel (14%) than to concomitantly grafted arteries (6%). No correlation was found between the initial ischemic time interval and graft patency. Late left ventricular function was excellent or minimally impaired in 52% of these patients while 48% had significantly reduced LV function. Again, no correlation was found between the ischemic time interval and late LV function. LV aneurysm, however, occurred only in patients with an ischemia of more than 3 hours. Thrombolysis combined with early bypass surgery represents the optimal therapy for acute myocardial infarct.(ABSTRACT TRUNCATED AT 250 WORDS)