Related Experiment Videos
[Reinfarction after initially successful thrombolysis in acute myocardial infarct]
Insights
A residual stenosis of at least 50% after successful thrombolysis for myocardial infarction significantly increases re-infarction risk. Second interventions are recommended in such cases to prevent re-occlusion.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Intracoronary streptokinase infusion is a treatment for acute myocardial infarction.
- Reocclusion of the infarct artery can occur within four weeks after successful treatment.
Purpose of the Study:
- To investigate the risk factors for reocclusion after intracoronary streptokinase infusion.
- To determine the impact of residual stenosis on reinfarction risk.
Main Methods:
- Retrospective analysis of 77 patients treated with intracoronary streptokinase for transmural myocardial infarction.
- Comparison of patient characteristics and outcomes between groups with and without reocclusion.
- Assessment of residual stenosis after treatment, with and without adjunctive balloon dilatation.
Main Results:
- Reocclusion occurred in 31% of patients within four weeks.
- Patients with reocclusion had significantly higher residual stenosis (75%) compared to those without (62%).
- No reocclusion was observed in patients with less than 50% residual stenosis.
Conclusions:
- A residual stenosis of at least 50% post-thrombolysis indicates a high risk of reinfarction.
- Second intervention is advised for patients with significant residual stenosis after initial thrombolysis.
Unlabelled:
In 24 of 77 patients (31%, group A), successfully treated by intracoronary streptokinase infusion in the acute stage of a transmural myocardial infarction, reocclusion of the infarct artery occurred within four weeks, in 15 patients with, in the remaining nine without re-infarction symptoms. The age of the patients, frequency of single, double or triple-vessel disease, number of anterior and posterior wall infarcts, creatine-kinase activity before and during treatment, and degree of stenosis at first contrast-medium injection were all comparable in the patients with or without re-occlusion (53 patients, group B). At the end of the acute treatment, in five patients of group A (21%) and in 17 of group B (32%) combined with balloon dilatation at the same time as the infusion, residual stenosis was significantly higher in group A than group B (75%) and 62%, respectively; P less than 0.001). No patient with a residual stenosis of less than 50% (18, of whom 12 had balloon dilatation) had a re-occlusion.
Conclusion:
A residual stenosis of at least 50% after initially successful thrombolysis presents a marked re-infarction risk and should lead to a second intervention in such cases.