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[Combined use of thrombolysis and PTCA in myocardial infarct. Effect on global and regional ventricular function]
Insights
Combined thrombolysis and angioplasty improved left ventricular function in myocardial infarction patients. This approach increased reperfusion rates and shortened infarct times, enhancing coronary blood flow and overall cardiac function.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiovascular Research
Background:
- Acute transmural myocardial infarction requires prompt reperfusion to preserve left ventricular function.
- Thrombolysis therapy is a primary treatment, but its efficacy can be limited by vessel reocclusion.
- Percutaneous coronary transluminal angioplasty (PTCA) offers mechanical revascularization but carries its own risks and success rates.
Purpose of the Study:
- To evaluate the combined effects of thrombolysis and PTCA on global and regional left ventricular function in acute myocardial infarction.
- To compare the outcomes of thrombolysis alone versus combined thrombolysis and PTCA in terms of reperfusion and left ventricular function.
- To assess the impact of mechanical recanalization success on reocclusion rates and cardiac function.
Main Methods:
- 127 patients with acute transmural myocardial infarction were randomized into two groups: thrombolysis alone (Group I, n=64) and thrombolysis with PTCA (Group II, n=63).
- Intravenous and intracoronary streptokinase were administered. PTCA was performed for occluded infarct-related vessels.
- Left ventricular function was assessed, and coronary angiography was used to evaluate vessel patency and reperfusion rates.
Main Results:
- The combined thrombolysis and PTCA group showed a trend towards higher initial vessel patency but similar reperfusion rates (92% vs 89%) compared to thrombolysis alone.
- PTCA success rate was 65% with a 4% reocclusion rate during the procedure.
- Improvement in regional and global left ventricular function was observed with PTCA, particularly in anterior myocardial infarction patients.
Conclusions:
- Combined thrombolysis and PTCA can increase reperfusion rates and shorten infarct times, offering potential for full revascularization.
- This combined approach improves coronary blood flow and enhances both global and regional left ventricular function.
- Successful angioplasty is associated with lower reocclusion rates and improved cardiac function post-myocardial infarction.
Abstract:
The study was performed to evaluate the combined effect of thrombolysis therapy and percutaneous coronary transluminal angioplasty (PTCA) on global and regional left ventricular function. In 127 patients with acute transmural myocardial infarction combined intravenous (250 000 U) and intracoronary (50 000 U) streptokinase therapy was started. When the infarct related vessel was occluded mechanical recanalization was performed with recanalization by Gruentzig balloon catheters. Patients were randomized in two groups, group I, n = 64, thrombolysis without PTCA; group II, n = 63, thrombolysis with PTCA. Both groups demonstrated no difference in relation to sex, age, infarct location, as well as CPK levels and time between onset of symptoms and start of treatment. First coronary angiography showed an open vessel in 23/64 patients (36%) of group I and in 12/63 patients (19%) of group II (p less than 0.001). Mechanical recanalization with 3 F catheters could be achieved in 27/41 patients (66%) of group I and with 4 F catheters in 26/51 patients (51%) of group II. In 9/41 patients (22%) of group I and in 18/51 patients (35%) in group II reperfusion took place before mechanical recanalization could be performed or occurred during superselective thrombolysis therapy, when mechanical recanalization failed. Thus, reperfusion rate in group I was 59/64 patients (92%) and in group II 56/63 patients (89%). PTCA was attempted in 55/56 patients in group II with a success rate of 65% and reocclusion rate of 4%. During hospital stay, reocclusion occurred in 10/59 patients in group I (17%) and in group II in 9/55 patients (16%). The patients were divided in those with and without successful angioplasty. Reocclusion was found in 3/36 patients (8%) and 6/17 patients (35%), respectively. Improvement with PTCA of regional and global left ventricular function was observed in patients with anterior myocardial infarction. With combined medical-mechanical recanalization, reperfusion rate can be increased and infarct time shortened, thus, providing the possibility of full revascularization by PTCA, improving coronary blood flow as well as improving global and regional left ventricular function.