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[Thrombolytic therapy and balloon dilatation. The effect on infarct time, reperfusion and reocclusion]
Insights
This study found that combining thrombolysis with balloon angioplasty (mechanical recanalization) improved reperfusion rates and reduced re-occlusion in acute myocardial infarction patients compared to thrombolysis alone. This approach enhances treatment effectiveness for heart attacks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Acute transmural myocardial infarction requires prompt restoration of blood flow.
- Thrombolysis is a primary treatment, but recanalization rates can be improved.
- Adjunctive mechanical methods may enhance recanalization and reduce re-occlusion.
Purpose of the Study:
- To compare the efficacy of thrombolysis alone versus combined thrombolysis and balloon angioplasty for recanalization in acute myocardial infarction.
- To evaluate reperfusion rates, re-occlusion rates, and long-term outcomes in both treatment groups.
Main Methods:
- 127 patients with acute myocardial infarction received initial streptokinase therapy.
- Patients with occluded infarct vessels were randomized to thrombolysis alone (Group I) or thrombolysis with balloon angioplasty (Group II).
- Coronary angiography was used to assess infarct vessel status and treatment success.
Main Results:
- Reperfusion rates were high in both groups (92% for thrombolysis alone, 89% for combined therapy).
- Re-occlusion rates were significantly lower after successful balloon angioplasty (8%) compared to failed angioplasty (35%) and higher in the thrombolysis-alone group during hospitalization (17%) and follow-up.
- Combined drug-mechanical recanalization led to increased reperfusion and reduced re-occlusion rates.
Conclusions:
- Combined thrombolysis and balloon angioplasty is an effective strategy for improving reperfusion and reducing re-occlusion in acute myocardial infarction.
- This approach facilitates full revascularization and offers a potential reduction in re-occlusion rates.
- The findings support the use of combined interventional techniques for acute myocardial infarction management.
Abstract:
127 patients, admitted within six hours of onset of symptoms of acute transmural myocardial infarction, received at first 250 000 U streptokinase intravenously over 20 min, followed by an intracoronary infusion of 250 000 U after coronary angiographic demonstration of the infarct vessel. Those in whom the infarct vessel was closed were randomized into two groups. An attempt at recanalization was made either by thrombolysis alone, through a specially developed 3F catheter (group I, 64 patients), or by thrombolysis and dilatation with 4F Grüntzig balloon catheter (group II, 63 patients). There was no significant difference between the two groups with regard to sex, age, infarct site, creatine-kinase level and interval between onset of symptoms and treatment. Re-perfusion rate for group I was 92% (59 patients), for group II 89% (56 patients). Re-occlusion during the hospital stay occurred in 10 of 59 patients in group I, in 9 of 55 in group II. Re-occlusion occurred in only 8% (3 patients) after successful dilatation, but in 35% (6 patients) after failed dilatation. In the subsequent six months further occlusions were observed in seven group I and two group II patients. Combined drug-mechanical recanalization thus increased the re-perfusion rate, shortened the infarction time and made possible full revascularization by subsequent dilatation which led to a reduction in the re-occlusion rate.